355.U5 


The  Sick  and  Disabled 

Ex- Service  Men 

of  Illinois 


BY 
MYRON  E.  ADAMS 

hXECtXIVE   MANACER 

Four  SHF.RIUAN   ASSOC!  \1  ION 

CHICAGO 


INTkODL'CTION  BY 

MAJOR  GENERAL  LEONARD  WOOD 


'    ■/ 


Compiled  from  a  census  made  during  the  month  of 

December  of  1920,  January  and  February  of  1921, 

for  the  Henry  Blair  Keep  Post,  American  Legion. 

Chicago,  by  John  W.  Lyden 


r:re^o:rrtrpe°.^'^°"*' 


,suy  o(  lUinois^U^SS 


1.161- 


-llAl 


The  Sick  and  Disabled 

Ex-Service  Men 

of  Illinois 


BY 

MYRON  E.  ADAMS 

EXECUTIVE   MANAGER 

FORT  SHERIDAN  ASSOCIATION 


INTRODUCTION  BY 

MAJOR  GENERAL  LEONARD  WOOD 


Compiled  from  a  census  made  during  the  month 

of  December  of  1920,  January  and  February  of 

1921,  for  the  Henry  Blair  Keep  Post,  American 

Legion,  Chicago,  by  John  W.  Lyden. 


FORT  SHERIDAN  ASSOCIATION 

21  North  La  Salle  Street 

Chicago 


/\> 


CONTENTS 


Introduction  by 
MAJOR  GENERAL  LEONARD  WOOD 


Foreword  by 
ABEL  DAVIS,  CHAIRMAN 

National  Hospitalization  Committee  of  American  Legion 


Statement  by 

A.  A.  SPRAGUE,  Commander 

HENRY  BLAIR  KEEP  POST 

of  the  American  Legion,  Chicago,  111. 


THE  SICK  AND  DISABLED  EX-SERVICE  MEN  OF  ILLINOIS 
By  JNIyron  E.  Adams 


^ 


C  ONTENTS— Continued 

Histoiy  of  Hospital  Care 
Purpcso  and  Method  of  Census 

GENERAL  INFORMATION 

A.  Wide  distribution  of  patients. 

B.  Temporary  character  of  provisions. 

C.  Lack  of  check  and  centralized  information. 

D.  Lack  of  general  hospital  facilities. 

E.  Occasional  bad  conditions. 

SPECIFIC  INFORMATION 

A.  Tuberculosis. 

B.  Nervous  and  mental  cases. 

C.  General  medical  cases. 

D.  AYar  Risk  Bureau. 

(a)  Compensation. 

(b)  Insurance. 

E.  f  nited  States  Public  Health  Service. 

F.  Federal  Board  for  Vocational  Education, 

G.  American  Legion  Co-operation. 
H.  American  Red  Cross. 

SPECIFIC  SUGGESTIONS  FOR  THE  FUTURE 

A.  Completion  of  the  Speedwa}"  Hospital, 

B.  A  State  Hospital  for  Mental  Cases, 

C.  Training  Farm  for  After-Hospital  Care  of  Mental  Cases. 

D.  Complete   Unification,  Departmentalization   and  Decen- 

tralization   of    Government   Bureau,    caring    for    Ex- 
Service  Men. 

E.  Clinics  ;ind  Home  Visitation. 

4 


INTRODUCTION   BY  MAJOR  GENERAL  LEONARD  WOOD 

Under  a  sound  conception  of  citizenship  equality  of  obligation 
goes  hand  in  hand  with  equality  of  privilege.  We  demand  the 
latter;  ice  must  give  the  former.  The  nation  has  given  us  every- 
thing in  the  way  of  equality  of  privilege  and,  as  far  as  is  humanly 
possible,  equality  of  opportunity,  and  demands  in  no  uncertain 
terms  equality  of  obligation, — obligation  to  serve  wherever  one 
can  best  serve,  this  to  be  determined  by  the  Government. 

The  Draft  system  employed  by  us  in  the  World  War  embodied 
the  spirit  and  principal  of  Universal  Obligation  for  Service,  serv- 
ice somewhere,  wherever  one  could  best  serve.  It  was  accepted 
by  our  people  without  a  murmur,  and  for  the  first  time  in  our 
history  in  a  great  war  ive  did  not. resort  to  the  bounty  system  or 
to  that  most  degrading  practice  of  purchasing  substitutes  by  those 
who  were  umvilling  to  risk  their  lives  on  the  battlefield. 

We  must  keep  alive  this  sentiment  of  universal  obligation  and 
this  spirit  of  service  regardless  of  selfish  interests.  In  order  to 
do  so  the  nation  must  demonstrate  that  it  appreciates  the  sacrifices 
which  have  been  made  by  the  fighting  forces  and  that  it  intends  to 
take  care  of  all  those  who  have  been  disabled  in  service  and  to 
restore  to  the  best  possible  condition  those  who  have  been  wounded 
or  disabled  as  a  result  of  service.  The  dead  cannot  be  called  back, 
but  many  of  the  crippled  and  sick  can  be  restored  to  usefidness, 
and  the  best  possible  means  must  be  furnished  to  this  end.  Shell- 
shocked  and  nervous  cases  must  be  assembled  under  the  most  favor- 
able conditions  in  a  section  of  the  country  which  lends  itself  to  out- 
door activities  and  to  life  in  the  open,  under  conditions  of  sunshine 
and  fresh  air,  which  give  inspiration  and  hope.  Hospitals  for  the 
permanently  insane  are  not  suitable  for  this  class  of  cases.  Those 
who  are  suffering  from  tuberculosis,  old  bone  injuries  which  refuse 
to  heal,  from  injury  to  the  nerves,  in  fact,  all  that  long  category  of 
chronic  cases,  where  recovery  depends  so  much  upon  suitable  sur- 
roundings, the  right  kind  of  climate,  fresh,  stimulating  air,  etc.,* 
must  be  given  every  opportunity  for  recovery.  Almshouses,  no 
matter  how  well  kept,  are  not  suitable  places  for  our  wounded 
veterans,  nor  are  our  Old  Soldiers'  Homes.  Fine  as  the  inmates 
are,  they  are  most  of  them  waiting  for  the  end  of  life.  Our  patients 
are  at  the  beginning  of  ihe  road  with  life  ahead.  There  should  be 
no  farming  out  of  the  war  cripples  and  invalids.  Investigations 
have  disclosed  too  many  men  in  utterly  unsuitable  places.     The 

5 


surroundings  of  our  hospitals  for  the  sick  and  crippled  of  the  war 
must  he  cheerful,  good  grounds,  reasonable  sources  of  amusement, 
and  an  opportiinitg  for  much  outdoor  life.  Our  large  divisional 
hospitals  in  the  Southive^t,  West  and  in  other  sections  of  the  coun- 
try are  comparatirehj  new  and  can  he  readily  used.  The  high 
plateaus  of  the  Southwest,  with  their  dry,  hracing  air,  have  demon- 
strated a  thousand  times  their  health-giving  qualities.  This  is  the 
general  area  in  which  these  classes  of  cases  should  he  assemhled. 

The  soldier  invalids  should  he  placed,  as  far  as  possible,  in 
special  hospitals  which  would  have  a  spirit  of  their  own,  an  interest 
of  their  own,  and  everything  pertaining  to  compensation,  hospital- 
ization, educational  and  vocatio7ial  training  should  he  under  the 
charge  of  some  single  head,  preferably,  as  I  see  it,  an  assistant 
Secretary  of  War.  These  sick  men  have  heen  soldiers,  and  it  is 
under  the  care  of  the  Army  that  they  should  find  the  most  sym- 
pathy and  the  keenest  interest. 

We  cannot  do  too  much  for  those  who  have  offered  everything, 
even  life  itself,  in  our  efforts  to  restore  their  crippled  bodies  to  use- 
fulness, to  implant  again  in  their  souls  the  fires  of  hope,  to  make 
them  feel  that  the  world  is  still  a  good  place  to  live  in  and  that 
there  is  much  that  is  iisefid  and  helpful  that  they  can  do,  and  to 
show  them  that  we  have  not  forgotten  their  service.  In  a  word,  to 
make  them  again  useftd  citizens  of  the  nation,  men  full  of  hope  and 
energy,  looking  ahead  io  a  usefid  career,  and  not  despondent  vet- 
erans left  in  unsuitable  hospitals,  seeking  health  in  unhealthful 
places,  gradually  losing  hope,  slowly  passing  beyond  the  point 
where  help  can  he  extended  to  them  with  any  hope  of  success. 

We  wa7it  to  keep  alive  the  spirit  of  service.  It  can  best  he 
kept  alive  by  prompt  and  effective  recognition  and  care  of  those 
who  have  served. 

(Signed)     LEONARD  WOOD 


Fort  Sheridan,  III.,  March  34,  1921. 

6 


FOREWORD 

BY 

Chairman  National  Hospitalization 
Committee  of  the  American  Legion 

Your  report  on  the  surve^^  of  disabled  ex-soldiers  and  hospitals 
of  Illinois  is  an  admirable  presentation  of  facts,  conclusions  and 
recommendations  for  the  future.  We  have  rounded  the  corner. 
Our  time  and  effort  have  been  concentrated  heretofore  on  indicat- 
ing the  difficulties;  your  report,  based  on  facts  and  supported  by 
your  survey,  points  the  way  to  a  concrete  line  of  helpfulness  by 
the  Government,  the  American  Legion,  and  the  public  at  large. 
Truly,  the  splendid  sons  of  America  who  still  suffer  from  their 
contribution  to  the  cause  of  their  country  may  look  hopefully 
toward  the  future. 

Sincerely  yours, 

ABEL  DAVIS 
Chicago. 


A  STATEMENT  BY  THE  COMMANDER  OF  HENRY  BLAIR 
KEEP  POST,  THE  AMERICAN  LEGION 

Considerable  experience  on  the  National  Beneficial  Legislative 
Committee  and  later  on  the  Hospitalization  Committee  of  the 
American  Legion,  conclusivel}^  proved  two  points  to  my  mind. 

First — That  the  governmental  bureaus  themselves  were  greatly 
in  need  of  information,  accurate  and  up-to-date,  concerning  their 
own  wards  and  patients. 

Second — That  the  general  public,  the  legislators  of  the  country, 
and  last,  but  not  least,  the  ex-service  people,  whether  members  of 
the  American  Legion  or  not  needed  exact  and  accurate  information 
as  to  the  kind  of  care  being  given  to  those  still  receiving  medical 
and  surgical  care,  the  number  needing  some  sort  of  treatment  and 
not  receiving  it.  This  applies  particularly  to  tuberculosis  and 
mental  diseases,  and  primarily  what  should  and  could  be  done  by 
the  nation.  To  get  this  national  action  it  became  apparent  that 
an  educational  campaign  must  be  carried  on. 

With  these  points  in  mind  I  feel  that  the  Legion — and  this 
applies  to  every  post  as  well  as  to  the  National  Organization — 
in  order  to  warrant  its  existence  must  have  some  definite  purpose 
in  mind,  other  than  that  of  having  meetings,  to  hear  speeches,  or 
to  give  entertainments  or  dances.  When  I  was  honored  by  being 
made  commander  of  the  Henry  Blair  Keep  Post  No.  462,  a  plan 
was  first  laid  before  its  executive  committee  and  later  before  the 
post,  which  was  unanimously  adopted. 

This  plan  contemplated  the  taking  of  a  census  of  every  ex- 
service  person  in  every  hospital  in  the  State  of  Illinois.  The 
major  part  of  the  expense  for  this  w^ork  was  covered  by  a  voluntary 
assessment  of  the  membership  of  the  Post,  and  the  work  has  been 
very  carefully,  accurately  and  economically  done  by  J.  W.  Lyden, 
who  has  had  considerable. experience  in  this  sort  of  work. 

The  census  which  was  taken  was  valuable  in  itself,  but  the 
greatest  value  was  in  the  by-product  or  information  that  it  gave, 
definitely  proving  the  need  of  many  reforms  and  changes.  The  real 
good  from,  this  work  will  be  widespread  and  lasting,  is  my  belief, 
and  to  the  Post  and  one  whose  interest  in  the  post  has  never  flagged, 
are  due  not  only  my  thanks  for  making  possible  this  work,  but 
the  thanks  of  many  w^ho  have  already  benefited  by  the  work  and 
the  many  more  who  will  benefit  just  as  much,  even  if  indirectly. 

The  thanks  of  the  wounded  ex-service  men  and  women,  of 
every  member  of  the  American  Legion  and  of  all  citizens  of  the 
United  States  interested  in  paying  this  debt  to  their  defenders, 
are  due  to  one  man,  a  man  of  great  experience,  of  great  heart,  of 
great  vision,  and  great  name — General  Leonard  Wood.  His  coun- 
sel and  assistance  in  this  work,  as  well  as  in  every  effort  that  has 
been  made  in  the  State  of  Illinois,  have  been  of  the  greatest  help 

^"^^  ^^^""^^-  A.  A.  SPRAGUE, 

Commander  Henry  Blair  Keep  Post  No.  462,  Chicago,  111. 

8 


THE  SICK  AND  DISABLED  EX-SERVICE  MEN  OF  ILLINOIS 

By  Myron  E.  Adams 

We  want  yon  to  know  the  facts  about  the  sick  and  disabled 
men  of  Illinois.  They  have  been  gathered  carefully  and  honestly. 
The  truth  is  bad  enough.  Exaggerations  or  the  stressing  of  excep- 
tions simply  prevent  the  consideration  of  the  real  issues. 

The  duty  of  our  country  to  give  the  best  care  to  sick  and 
disabled  ex-service  men  is  not  a  charity,  but  a  matter  of  common 
justice  and  an  essential  link  in  any  future  policy  of  National 
defense.  We  have  bungled  our  care  of  these  men;  we  have  not 
kept  our  promises  made  to  them  and  to  their  families.  It  is  true 
we  left  it  to  others — to  Government  Bureaus,  to  Welfare  Agencies, 
to  kindly  friends. 

It  was  our  job — we  thought  so  once.  We  were  grateful;  we 
cheered  for  them  at  Chateau  Thierry,  at  St.  Mihiel  and  the 
Argonne.  Each  man  enriched  his  personal  pride  as  well  as  his 
personal  security  at  the  cost  of  their  suffering,  but  we  did  not 
intend  to  remain  their  debtors — that  was  unthinkable !  We  would 
not  let  Government  Bureaus  monopolize  the  thrill  and  the  pride 
on  Armistice  Day — why  let  a  few  feel  the  entire  responsibility  now  ? 

Hospitals  are  needed  exclusively  for  ex-service  men, 
built  entirely  with  their  interests  at  heart.  There  must 
be  a  unification  of  agencies  responsible  for  their  care; 
it  must  be  made  easy  for  any  ex-service  man  to  get 
quick  and  fair  consideration  of  his  claim.  Every  known 
achievement  of  medical  science  must  be  made  avail- 
able to  restore  the  health  and  strength  the  nation  was 
compelled  to  use  for  its  defense.  Increasing  co-opera- 
tion must  be  secured  from  universities,  industries,  pro- 
fessions and  citizens  generally  to  reassure  the  replace- 
ment of  the  man  disabled  in  mind  or  body  in  a  useful 
self-respecting  place  in  society.  Nor  should  we  forget 
the  unspeakable  debt  we  owe  to  those  who  have  given 
husband,  father,  son  or  brother  to  their  country. 

Here's  the  way  they  did  it  "over  there": 

His  commanding  officer  wrote,  ' '  He  carried  his  platoon  through 
to  the  objective,  and  then  ordered  the  men  to  'dig  in'  and  to  get 
under  cover.  While  they  were  doing  this  he  noticed  several 
wounded  men  lying  in  the  open,  exposed  to  machine  gun  fine  and 
snipers'  bullets.  He  called  for  volunteers  to  go  with  him  to  bring 
in  the  wounded,  and  with  two  non-commissioned  officers  he  went 
out  and  carried  back  three  of  the  wounded.  He  started  on  the 
second  trip,  but  just  as  he  passed  a  stone  wall  several  rifles  opened 
fire  on  the  party  and  Lieutenant  Hoyer,  who  was  in  advance,  fell 
forward  on  his  face — dead." 


That  Avas  llic  i)ii('e  incii  willingly  ])ai(l  1o  take  care  of  their 
wounded  comrades  overseas.  Under  the  white  crosses  on  the  liill- 
sides  of  France  lliere  rests  today  a  l)rav('  Company  of  men  wlio 
gave  their  lives  that  their  wounded  comrades  might  come  back 
home  and  get  a  fighting  ehauee  toward  a  normal  life  again. 

In  1919,  when  the  tighting  men  were  returning  from  overseas 
and  parading  before  their  welcoming  friends,  these  men,  with 
limbs  torn  by  enemies'  bullets,  or  with  minds  and  bodies  disturbed 
by  shell-shock  or  disease,  were  returned  to  great  Army  hospitals 
hastily  erected  for  temporary  occupancy.  They  passed  from  the 
seaboard  to  the  inland  hospitals,  in  the  main,  unnoticed.  Many 
of  them  were  too  wrecked  and  wretched  to  care,  but  all  were  glad 
to  get  back  home. 

Most  of  the  Illinois  men  were  brought  directly  to  Fort 
Sheridan.  Here  a  great  series  of  wooden  buildings  was  erected, 
the  stone  barracks  were  renovated,  and  an  immense  hospital  plant 
was  completed.  This  hospital  and  the  hotel  at  47th  and  Drexel 
Boulevard  housed  the  sick  and  disabled  ex-service  men  for  a  period 
of  a  year  and  one-half. 

The  first  returning  disabled  and  sick  ex-service  men  came  at 
a  time  when  there  was  a  great  deal  of  honest  appreciation  and 
genuine  consideration  for  these  men.  War  w^ork  agencies  Avere  still 
active;  Red  Cross  canteen  -workers  met  the  passing  trains;  Red 
Cross  recreational  buildings  Avere  erected  near  the  hospitals;  Y. 
W.  C.  A.  and  Y,  M.  C.  A.  buildings  w-ere  opened.  Libraries,  indoor 
and  outdoor  recreation,  and  vocational  education  were  furnished 
to  supplement  the  Avork  of  the  Army  Medical  Service.  Community 
hospitality  was  furnished  by  the  War  Camp  Community  Service 
and  other  organizations. 

Early  in  1920  it  was  evident  that  these  arrangements  were 
temporary;  efforts  w^ere  being  made  to  discharge  as  many  men  as 
possible;  medical  officers  were  resigning  from  the  Service.  The 
care  became  more  lax,  and  the  men. in  the  hospitals  began  to  show 
the  strain  of  their  long  hospitalization. 

It  was  in  October  that  the  care  of  these  men  was  transferred 
from  the  Army  Medical  Corps  to  the  Public  Health  Service.  On 
short  notice  the  military  hospitals  Avere  closed  and  dismantled — 
in  some  cases  actually  torn  down.  The  Public  Health  Service  was 
called  upon  to  secure  hospitalization  and  to  afford  medical  care 
and  physical  examination,  not  only  for  the  men  who  were  trans- 
ferred from  the  Army  hospitals,  but  for  all  claimants  of  the  War 
Risk  Bureau,  for  all  applicants  for  Vocational  Training,  and  in 
addition,  for  several  classes  of  Government  officials,  including  Post 
Office  employees  and  Merchant  Seamen. 

They  had  only  one  small  hospital  in  Chicago.  In  a  brief  period 
they  had  to  build  up  their  medical  personnel,  their  central  and 
sub-offices,  and  in  addition,  secure  sufficient  hospital  facilities  to 
care  for  these  men.     It  was  necessary  to  lease  the  hotel  at  47th 

10 


and  Drexel,  whicli  had  been  used  as  a  military  hospital;  also,  to 
make  arrangements  for  the  care  of  these  men  in  public  and  private 
hospitals  throughout  the  State,  as  there  were  no  central  hospitals 
available.  This  wide  distribution  of  patients  to  public  and  private 
institutions  was  in  the  nature  of  a  temporary-  expedient,  and  in  the 
eases  of  Tubercular  and  Neuro-psj'chiatric  cases,  failed  to  meet 
squarely  the  needs  of  ex-service  men,  and  often  subjected  them 
to  conditions  which  were  unfair  and  unsatisfactory. 

Earl}^  in  May,  1920,  a  National  Committee  on  the  Hospitaliza- 
tion and  Care  of  Sick  and  Disabled  Ex-Service  Men,  with  General 
Abel  Davis  as  Chairman,  was  appointed  by  the  National  Comman- 
der of  The  American  Legion.  This  Committee  surveyed  the  entire 
National  field,  and  found  that  there  were  three  great  problems: 
the  lack  of  speedy  and  efficient  co-operation  between  the  Bureaus  of 
Public  Health,  War  Risk  Bureau,  and  the  Bureau  of  Vocational 
Education;  the  lack  of  proper  public  hospital  facilities  available 
for  this  purpose;  the  lack  of  both  means  and  methods  of  properly 
caring  for  tubercular  and  mental  cases. 

THE  ILLINOIS  CENSUS 

While  engaged  in  the  work  of  consolidating  these  Bureaus  and 
securing  better  service  for  the  tubercular  and  mental  cases,  the 
Committee  realized  the  need  of  a  more  careful  census  of  men 
actually  in  hospitals,  in  order  that  the  facts  might  be  secured. 
Through  the  co-operation  and  support  of  the  Henry  Blair  Keep 
Post,  A.  A.  Sprague,  Commander,  and  Dr.  George  de  Tarnowsky, 
Chairman  of  the  Medical  Committee,  a  census  of  the  disabled  and 
sick  ex-service  men  in  the  State  was  made  by  John  W.  Lyden,  for- 
merly Assistant  Director  of  the  Service  Department  of  the  Amer- 
ican Legion  of  Illinois. 

Day  after  daj',  for  two  mouths,  Lyden  Avent  through  all  the 
hospitals  of  Illinois,  starting  at  Chicago  and  going  south  as  far 
as  the  Ohio  River.  He  talked  with  each  man  individually,  listened 
to  their  stories,  heard  their  complaints,  consulted  with  nurses, 
physicians,  welfare  workers,  local  representatives  of  the  American 
Legion,  always  keeping  in  mind  that  the  main  purpose  was  to 
be  personally  helpful  to  these  men,  as  well  as  to  improve  their 
general  conditions,  and  those  of  the  men  who  came  after  them. 

The  Census  disclosed  that  there  were  approximately  1,200  ex- 
service  men  in  hospitals  of  Illinois.  This  number  varies  monthly 
and  the  average  will  run  from  1,200  to  1,600.  250  were  in  Tuber- 
culosis hospitals,  400  in  Mental  hospitals  and  550  in  General  Medi- 
cal and  Surgical  hospitals. 

The  General  Medical  and  Surgical  cases  were  in  3  U.  S.  P.  H. 
Service  hospitals  and  in  23  private  and  public  contract  hospitals. 
The  Tuberculosis  cases  were  in  12  hospitals  and  the  Mental  cases 
were  in  1  Public  Health  Service  hospital  and  in  10  private  and 
public  contract  hospitals. 

11 


The  ini'orniatioii  was  secured  on  this  form  card: 

1  2  3  4  5 

HOSI'ITAL  19: 

Sur  Name Given  Name 

Claim  No Serial  No Age 

Home    Address 

Street  City  or  Town  State 

Married No.  of  Dependents Condition  of  Dependents 

Nearest   Kin 

Name  Street  City  or  Town  State 

Date  of  Enlistment Rank Org Date  of  Dis 

Diagnosis    

Date  and  Source  of  Admission 

Approximate  Date  of  Discharge .'.. 

Compensation — Date   Filed Amount  Awarded 

Occupation Where By   Whom 

Resume    Former    Occupation? : 

Best  Friend 

Name  Street  City  or  Town  State 

Insurance    ^ 

Remarks    


As  soon  as  the  information  was  -secured  it  was  copied  on  4 
duplicate  cards  and  sent  immediately  to  American  Legion  Head- 
quarters, to  the  War  Risk  Bureau,  the  Board  of  Vocational  Train- 
ing and  the  U.  S.  Public  Health  Service.  In  this  \xay  there  was  a 
.check  up  by  these  departments  and  delayed  action  was  remedied 
as  soon  as  possible. 

The  census  showed  that  50%  of  the  men  wdio  w-ere  in  Mental 
Hospitals  were  overseas  men.  10%  were  from  the  Navy  and  40% 
from  noncombatant  units.  A  larger  percentage  of  overseas  men 
were  found  among  the  Tubercular  and  a  somewhat  larger  per- 
centage among  the  surgical  cases.  There  were  720  men  unmarried 
and  315  with  families,  among  which  the  majority  had  other  de- 
pendents. 

GENERAL  INFORMATION 

The  disabled  and  sick  ex-service  men  of  Illinois  are  widely 
distributed.  There  were  nine  hospitals  used  in  Chicago,  and  fifty- 
one  hospitals  in  the  State  outside  Chicago,  at  the  time  of  the 
census.  The  largest  hospital  in  Chicago,  at  Drexel  and  47th  Street, 
houses  from  250  to  500  patients,  while  many  of  the  smaller  hos- 
pitals throughout  the  State  have  only  one  or  two. 

The  impression  of  the  temporary  character  of  all  arrangements 
is  evident  througliout  the  entire  State.  It  is  purely  an  emergency 
situation.  The  hospitals  make  arrangements  under  pressure.  In 
the  majority  of  cases  they  will  w'elcome  the  centralized  care  of 
these  men  in  Government  institutions.  They  recognize  a  respon- 
sibility, which  arises  from  the  fact  that  ex-service  men  have  special 
claims  on  the  Government  for  a  type  of  care  Avhich  they  are  often 
not  equipped  1o  ])rovide.  The  Government  is  very  slow  in  pay- 
ments for  hospilal  care,  and  very  exacting  on  detailed  financial 
i-eports.  The  slightest  mistake  often  holds  up  entire  payments 
for  long  periods.    The  patients  are  constantly  being  changed  from 

12 


hospital  to  hospital.  They  also  realize  that  the  complaints  of  some 
bed-weary,  despondent  ex-service  man  may  cast  a  cloud  of  sus- 
picion over  their  hospital  record.  All  these  facts,  and  many  others, 
conspire  to  make  the  majority  of  public  and  private  hospitals 
anxious  to  have  the  care  of  these  men  centralized  where  construc- 
tive plans  can  be  made  and  special  work  developed  to  meet  the 
special  needs. 

There  is  an  evident  lack  of  centralized  information.  The 
Public  Health  Service  does  not  keep  accurate  reports  of  the  men 
in  hospitals  at  any  one  time,  and  there  is  no  system  of  supervision 
by  which  the  Governmental  agencies  are  kept  in  personal  touch 
with  the  patients.  This  results  frequently  in  overcrowding  and 
bad  conditions.  For  example,  the  census  of  St.  Paul's  Hospital, 
a  private  contract  hospital  at  828  W.  35th  Place,  Avas  made  on 
December  30th.  It  had  a  20-bed  capacity.  There  were  five  ex- 
service  men  there,  and  two  weeks  later  twenty -five  more  ex-service 
men  were  sent  there.  It  became  over-crowded  and  dirty,  and  a 
public  scandal  resulted.  The  men  were  all  removed.  A  similar 
complaint  was  made  in  another  case,  and  overcrowding  stopped. 
The  tremendous  pressure  of  men  needing  hospital  care,  and  the 
lack  of  hospital  facilities,  makes  this  situation  inevitable  without  a 
constant  check  up  on  the  men  actually  in  hospitals,  and  a  personal 
supervision  by  the  Public  Health  Service. 

Every  Hospital  in  which  an  ex-service  man  was  placed  by  the 
Public  Health  Service  was  visited  during  the  months  of  December, 
January  and  February.  The  medical  care,  personal  attention  and 
consideration  and  general  treatment  given  to  ex-service  men  was 
good.  The  real  difficulties  lay  along  the  line  of  more  adequate 
hospital  facilities,  the  special  care  needed  for  all  mental  and  tuber- 
cular diseases,  and  the  proper  functioning  of  the  War  Risk  Bureau 
and  the  Public  Health  Service. 

TUBERCULOSIS 

The  Tubercular  Patient 

The  medical  care  of  the  tubercular  ex-service  man  is  an 
enormous  outstanding  problem.  There  is  a  vast  difference 
between  his  situation  and  that  of  the  general  medical  patient. 
He  bears  no  outward  sign  of  his  contribution  to  his  country's 
service.  Mechanical  and  surgical  skill  have  combined  to  help 
the  man  who  has  lost  leg  or  arm  or  other  physical  parts,  to  a 
place  of  real  usefulness.  Often  he  has  health,  strength,  ambi- 
tion and  resolution  to  overcome  his  handicap,  and  to  assist  in  his 
speedy  restoration. 

The  tubercular  soldier  has  had  a  different  lot.  Some  have 
been  held  back  through  the  war  period  from  active  participation 
in  the  Service  because  of  the  development  of  the  disease  under 
earlier  hardships ;  others  have  developed  it  in  the  active  Service, 
and  while  outwardly  untouched,  have  been  inwardly  marked  for 
periods  of  tedious  and  lonely  isolation  in  quiet  hospitals,  and  no 
prospect  of  speedy  return  to  normal  work-a-day  life. 

13 


There  are  three  features  of  the  problem  in  Illinois:  The 
first  is  the  large  number  of  tubercular  men  not  in  hospitals.  No 
accurate  estimate  has  been  or  could  be  made,  but  it  is  several 
times  the  number  in  hospitals.  There  are  various  reasons.  Incip- 
ient cases  often  are  cared  for  at  home,  sometimes  under  medical 
supervision,  but  frequently  without  any  attention  or  care.  Some, 
through  sheer  ignorance  or  carelessness,  delay  seeking  medical 
care,  or,  having  sought  it,  ignore  the  only  treatment  which  could 
assure  them  a  return  to  health  and  strength.  Others  resent  the 
idea  of  going  to  a  hospital,  fearing  the  period  of  loneliness,  and 
eagerly  seek  some  excuse  in  the  nature  of  the  hospitalization  which 
they  can  offer  for  not  going.  Among  many  ex-service  men,  in 
addition,  there  has  long  been  noticed  a  certain  natural  nervous 
dissatisfied  attitude  toAvard  the  quietness  and  passivitj^  of  the  hos- 
pital treatment  required,  which  causes  them  to  break  away  from 
restraints  and  to  hazard  their  physical  future  at  whatever  cost. 
This  situation  cannotibe  ignored.  It  has  already,  and  will  increas- 
ingly, contribute  a  vast  army  of  men  to  the  incapacitated  citizens 
of  America. 

The  following  report  supports  this  conclusion.  These  ex- 
service  men,  who  were  under  treatment  at  the  Municipal  Tubercu- 
losis Sanitarium  of  Chicago,  were  discharged  during  the  months 
of  January  and  February',  1921.  There  were  forty-two  men  in 
this  hospital  on  January  1st,  forty-one  men  on  February  1st — 
six  were  admitted  during  the  month  of  February. 


A- 
C- 
H- 
J- 
R- 
11- 
S- 
B- 
B- 
C- 
D- 
0- 
R- 
S- 

s- 
s- 
s- 

V- 
W- 
W- 


NAME 

—  W- 

—  J- 

—  R- 

—  C- 

—  A- 

—  F- 
E- 
A- 
C- 
V- 

J- 

A- 
L- 
A- 
T- 
R- 
T- 
J- 
S- 
B- 


DATE  OF  DISCHARGE 

January  15, 1921 
January  2, 1921 
January  30, 1921 
January  30, 1921 
January  26, 1921 
January  27,  1921 
January  27,  1921 
February  22, 1921 
February  1, 1921 
February  2, 1921 
February  10, 1921 
February  7, 1921 
February  24, 1921 
February  27, 1921 
February  23, 1921 
February  2,  1921 
February  1,1921 
February  14,  1921 
Fel)i-uary  7, 1921 
February  24,  1921 

14 


REASON 

Own  Request 

Died 

Died 

Discipline 

Own  Request 

Discipline 

Truant 

Died 

Transfer 

Died 

Truant 

'Order  of  U.S.IMI.S. 

Own  Request 

Transfer 

Died 

Non  T.B. 

Transfer 

Transfer 

Discipline 

Discipline 


The  second  is  hospitalization.  Tliere  are  no  Public  Healtli 
or  Military  Tuberculosis  Hospitals  in  this  District.  Some  men 
have  been  sent  to  New  Mexico,  Arizona,  Colorado,  and  during; 
the  last  six  months,  to  the  new  Public  Health  Hospital  in  Johnson 
City,  Tennessee. 

At  the  time  of  the  census,  tuberculosis  patients  in  Illinois 
were  located  at  the  following  hospitals: 

Municipal  and  County  Institutions 

Chicago  Municipal  T.B.  Sanitorium,  Chicago 39 

Cook  County  Sanitarium,  Oak  Forest 80 

Fairview-McLean  County  Sanitarium,  Normal 13 

La  Salle  County  Sanitarium,  Ottawa 4 

Peoria  Municipal  T.B.  Sanitarium,  Peoria 4 

Adams  County  T.B.  Sanitarium,  Quincj'' 1 

Rock  Island  Municipal  Sanitarinm,  Rock  Island 2 

143 
Contract  Hospitals 

Chicago  Fresh  Air  Hospital,  Chicago 14 

Edwards  T.B.  Sanitarium,  Naperville 7 

Ottawa  T.B.  Colony,  Ottawa 12 

Palmer  Sanitarium,  Springfield 28 

Chicago   Municipal    Sanitarium,   Winfield 5 

66 

There  has  been  a  great  deal  of  dissension  about  tuberculosis 
hospitals,  particularly  the  one  at  Oak  Forest.  The  facts  are  as 
follows :  When  the  Public  Health  Service  took  over  the  medical 
care  of  ex-service  men  they  had  no  tuberculosis  hospital  in  the 
District.  The  number  of  applicants  for  hospitalization  increased 
very  fast.  They  filled  every  available  bed  in  private  and  public 
hospitals  in  Michigan,  Wisconsin  and  Illinois,  and  still  there 
were  very  many  serious  cases  left  over.  The  only  available  hos- 
pital was  at  Oak  Forest,  the  County  Poor  Farm.  Here  they  sent 
a  group  of  men  who  at  first  were  housed  with  the  other  patients. 
Complaints  were  made ;  they  were  separated  and  put  in  cottages 
and  in  separate  wards ;  a  Red  Cross  worker  was  sent  there  for 
recreational  work ;  and  while  complaints  about  the  food  continued, 
it  was  much  improved,  and  a  special  representative  of  the  U.  S. 
Public  Health  Service  was  sent  there  to  look  after  their  interests. 
The  situation,  due  to  publicity,  has  prevented  many  tubercular 
ex-service  men  from  seeking  hospital  care.  This  has  been  one 
of  the  worst  reactions.  In  addition,  the  men  there  feel  that  when 
anything  goes  wrong,  the  fact  that  they  are  at  a  County  institu- 
tion is  a  blow  at  their  self-respect,  and  they  know  that  they  are 

15 


entitled  to  the  best  of  care  l)y  tlie  Government  in  a  Government 
liospit^il,  and  not  in  a  County  institution.  This  applies  not  only 
to  Oak  Forest,  but  to  all  County  and  Municipal  institutions 
throughout  the  State. 

There  is  no  question  of  the  intense  need  of  a  local  tubercu- 
losis hospital  for  ex-service  men.  Such  a  hospital,  conducted  along 
the  best  lines,  -would  help  to  care  for  many  men  who  will  not  go 
to  the  hospitals  named.  It  would  bring  the  entire  group  under 
responsible  care  and  constant  inspection,  and  would  create  a 
psychological  condition  of  satisfaction  and  self-respect  among 
the  ex-service  men,  which  would  help  materially  in  effecting  a 
cure. 

The  third  is  training.  "The  training  of  the  tubercular 
patient,"  according  to  Dr.  H.  A.  Pattison,  of  the  National  Tuber- 
culosis Association,  "is  exceptional,  in  that  it  eliminates  strong 
physical  exertion,  continuous  effort  or  preparation  for  indoor 
occupations  or  outdoor  occupations,  with  physical  hazards.  The 
chief  function  of  the  training  is  to  keep  the  man's  mind  occupied 
in  useful  directions  so  that  his  cure  may  proceed  more  rapidly. 
The  fact  that  he  realizes  that  if  he  is  ever  to  live  as  a  self- 
respecting,  self-supporting  member  of  society,  he  must  readapt 
himself  to  occupations  in  most  cases  entirely  foreign  to  those  in 
learning  which  he  has  spent  his  formative  years,  often  over- 
whelms him  and  it  is  only  as  he  feels  the  possibility  of  entering  into 
a,  new  vocation  that  his  mind  reacts  happily  to  treatment  given, 
and  the  training  contributes  directly  to  his  recovery,  as  well  as 
to  his  future  ability  to  take  his  place  in  society." 

The  situation  of  those  Avho  are  not  in  hospitals,  the  wide 
distribution  of  the  men  in  public  and  contract  hospitals,  and  the 
type  of  training  which  the  Government  can  and  will  give  them, 
all  point  to  the  urgency  of  centralizing  this  work  where  it  can 
be  conducted  along  lines  which  are  somewhat  commensurate  with 
the  importance  of  the  problem. 

Out  of  the  209  tubercular  patients  interviewed,  thirteen  were 
from  t^he  United  States  Navy,  118  were  from  overseas  organiza- 
tions, and  72  were  from  non-combatant  or  organizations  which 
did  not  get  overseas.  Among  this  latter  number  there  were  a 
large  number  of  patients  whose  tubercular  condition  was  due  to 
the  terrible  effects  of  the  "Flu,"  which  left  so  many  of  them 
weak  and  handicapped  in  the  Winter  of  1918. 

At  the  time  of  writing  this  report  the  number  of  cases  ask- 
ing for  compensation  because  of  tuberculosis  is  increasing  faster 
than  for  any  other  physical  cause.  It  is  estimated  that  there  are 
now  a  minimum  of  1,000  who  would  profit  from  hospital  care  if 
the  proper  Government  facilities  were  available.  Tuberculosis 
patients  should  have  immediate  action  on  all  compensation  claims, 
as  the  failure  to  receive  attention  aggravates  tlieir  trouble  and 
prevents  a  state  of  mind  which  will  assist  in  their  cure. 

16 


MENTAL  AND  NERVOUS  DISEASES 

"Mental  and  nervous  diseases,"  Dr.  II.  Doii<ilas  Singer,  Di- 
rector of  the  Illinois  Psvcliopatliic  Institute,  states,  "differ  from 
other  diseases  by  reason  of  the  fact  that  they  affect  the  machinery 
which  controls  and  regiilates  the  action  of  t^lie  body  as  a  whole. 
Damage  to  the  nervous  system  disabled  the  connected  part  of  the 
body — it  i^ractically  cuts  off  that  part.  The  diseased  mind  is 
dift"erent.  The  man  can  use  his  body,  but  not  direct  it.  His 
physical  strength  becomes  dangerous  to  himself  and  others. 
Without  outward  sign  or  inward  warning,  he  may  jeopardize 
the  standing  his  Service  has  given  him,  by  irresponsible  acts.  The 
man  who  has  been  deprived  of  his  mind  has  made  the  greatest 
sacrifice  of  all;  he  has  been  changed  from  a  defender  of  his 
country  to  a  possible  menace  to  society. 

"To  earn  a  living  an^  to  occupy  a  position  which  will  bring 
satisfaction  and  happiness,  a  man  must  conform  to  the  rules 
which  society  establishes  as  a  safeguard  for  the  welfare  of  all. 
The  ability  to  choose  a  course  of  action  which  will  bring  this 
result  depends  upon  the  quality  of  brain  which  the  man  possesses 
and  the  training  he  has  received.  The  quality  of  brain  depends 
largely  upon  the  character  of  his  inheritance,  but  often  upon 
changes  produced  by  injury  or  disease.  A  brain  that  is  poor  in 
quality  from  birth  is  said  to  be  defective,  and  persons  with  such 
brains  are  classed  as  mental  defectives.  The  severest  form  of 
deficiency  is  called  feeble-mindedness. 

"Persons  with  minds  of  poor  quality  will  conduct  themselves 
without  conflict  with  social  regulations  only  when  conditions  are 
relatively  simple.  When  the  responsibilities  are  too  complex  or 
the  difficulties  too  great,  thej"  behave  irrationally." 

The  Selective  Draft  eliminated  over  72,000  men  for  this 
reason.  Some,  however,  were  accepted,  and  in  many  more  cases 
the  defect  was  so  subtle  that  it  was  not  capable  of  recognition. 

The  "Call  to  the  Colors"  completely  overturned  many  people 
who  had  settled  down  to  a  sphere  of  life  which  presented  only 
such  conditions  as  they  were  able  to  face.  It  brought  those  people 
face  to  face  with  new  conditions ;  many  broke  down  under  this 
strain,  and  some  later.  Some  succeeded  in  adjusting  themselves 
to  Armj^  life,  only  to  find  when  they  left  the  Service  aud  were 
once  more  placed  upon  their  own  responsibility,  that  thej-  had 
lost  the  powers  and  habits  which  had  previously  been  satisfactory. 

Dr.  T.  W.  Salmon,  Director  of  the  National  Society  of  Mental 
Hygiene,  in  answer  to  a  question  before  the  Congressional  Com- 
mittee, gave  an  excellent  illustration  of  this  fact,  when  he  testified  : 
"In  that  connection,  one  illustration  may  be  of  some  value.  J 
have  heard  it  said  sneeringly  by  those  who  do  not  believe  in  all 
this  fuss  about  ex-solcfiers,  that  they  know  of  a  feeble-minded 
man  who  was  taken  and  passed  and  drafted  into  the  Army,  and 
who  is  now  getting  compensation.  That  was  given  as  one  of  the 
most  glaa-ing  instances  of  improper  payment. 

17 


"Let  us  see  if  this  is  necessarily  so.  I  know  a  feeble-minded 
boy  wlio  was  drafted  into  the  Army,  and  wlio  is  iiot  gettinj? 
compensation.  He  used  to  stay  around  a  livery  stal)le.  lie  was 
an  illej^'itimate  child;  no  one  knew  who  his  father  was.  His 
mother  was  a  i)rostitute  who  had  left  town.  He  slept  on  the 
liay  in  tlie  stable  and  picked  up  a  quarter  or  half-dollar  here 
and  there  workino:  around  the  livery  stable  and  holding  horses. 
That  boy  had  found  a  level  for  himself  upon  which  he  could 
adjust  himself  even  with  his  feeble  mind.  It  was  pretty  low 
level,  but  he  was  not  a  charge  upon  anyone. 

"The  Draft  came  and  took  him.  His  mental  condition 
escaped  detection  until  he  had  been  six  month's  in  a  training 
camp;  and  then  he  was  discharged  and  sent  off  with  only  rail- 
road fare,  and  nobody  to  supervise  his  activities.  Since  that 
time  he  has  been  alcoholic  and  arrested  many  times-.  Before  that 
he  had  never  been  a.rrested.  He  has  had  his  whole  Avorld  and 
all  his  standards  of  living  dislocated.  I  think  that  where  a  boy 
like  that  had  been  taken  right  out  of  the  surroundings  in  which 
he  had  made  a  place  for  himself,  even  in  a  livery  stable,  the 
Government  ought  to  do  something  for  him.  We  took  this  feeble- 
minded boy,  who  had  found  his  own  level  where  he  was,  just 
as  we  ha,ve  found  our  own  levels,  and  dislocated  his  entire 
universe.  I  do  not  think  that  anybody  ought  to  give  him  $100 
or  $80  a  month,  but  I  think  the  Government  should  re-establish 
him  on  the  footing  that  he  had  before  the  War,  or  a  little  better. 
Tliey  cannot  make  a  mechanic  out  of  him ;  they  cannot  give  him 
an  education  through  the  Vocational  Board,  but  the}'  caji  give 
him  slight  compensation,  enough  to  make  up  for  his  defect,  and 
that  boy  can  be  put  back  where  he  was  before  the  "War.  That 
represents  the  very  bottom  of  this  list  of  mental  disorders  due 
to  the  War,  which  is  represented  at  the  top  by  a  man  with  a 
piece  of  shrapnel  in  his  brain.  I  do  not  think  we  can  afford  to 
draw  the  line  and  say  to  that  boy,  'You  are  responsible  for  your 
own  brain,  and  if  you  got  drafted  into  the  Army  a'ou  ought  to 
have  known  better.'  We  took  these  men  as  they  were,  and  I 
think  we  took  the  responsibility  for  any  injury  Ave  did  to  them." 

In  many  cases,  the  hardships  and  privations,  exposure, 
wounds,  gas,  excitement,  fear  of  failure  in  duty  and  the  con- 
demnation of  their  felloAvs,  gave  rise  to  actual  disease  and  damage 
in  the  brain,  Avith  a  consequent  loAvering  in  the  quality  of  the 
brain  Avith  Avhich  the  men  entered  the  service.  If  thci'o  had  been 
even  the  slightest  trace  of  disease  at  the  time  of  eidistment,  the 
conditions  of  service   Avould   have  magnified   and  developed  it. 

It^  Avill  thus  be  seen  that  the  strenuous  conditions  of  Avar 
serA'ice  liaA'e  operated  to  giA'C  rise  to  mental  disorders  in  many 
different  Avays,  and  that  these  defects  have  been  produced  in 
well-formed  as  Avell  in  poorly  developed  brains. 

"In  a  general  way,"  said  Dr.  Singer,  "avc  may  subdiA'ide 
mental  disorders  into  tAvo  groups.  First,  those  Avliich  represent 
more  or  less  difficulty  in  making  adjustments.     These  are  coni- 

18 


monly  called  psycho-neuroses  (many  of  them  were  labeled  shell- 
shock),  of  which  there  are  several  different  varieties,  such  as 
hysteria,  neurasthenia,  and  other  forms  of  neuroses.  The  second 
group  are  often  called  psychoses,  or  more  commonly,  insanity. 
They  differ  from  the  first  in  that  they  are  evidences  of  actual 
damage  to  the  brain.  The  most  frequent  varieties  are  called 
dementia  praecox,  manic-depressive  insanity,  and  general 
paralysis.  To  be  included  within  tliis  last  group,  though  not 
necessarily  insane  in  the  ordinary  sense,  is  a  group  of  conditions 
known  as  epilepsy.  Here  the  fit  is  the  most  characteristic  symp- 
tom, but  often  it  is  associated  with  brain  disease,  which  alters 
the  ability  of  the  individual  to  choose  his  course  of  action 
satisf  a.ctorily. ' ' 

The  prevalence  of  insanity  in  civilian  life,  without  the  abrupt 
changes  incident  to  war  service  is  well  illustrated  by  the  fact 
that  the  State  hospitals  of  Illinois  now  contain  approximately 
20,000  such  persons.  With  regard  to  psycho-neuroses,  we  have 
no  exact  figures,  but  they  are  conceded  to  be  one  of  the  most 
potent  causes  of  chronic  suffering,  dependency  and  economic 
inefSciency. 

It  must  also  be  recognized  that  the  full  effect  of  the  damage 
received  in  Army  service  to  the  nervous  and  mental  system  will 
not  be  evident  for  some  years  to  come.  Such  diseases  develop 
s1ow1a(»,  and  often  obscurely.  Unfortunately  there  is  also  attached 
to  them  an  unjust  stigma  on  the  part  of  society,  which  makes 
it  difficult  to  secure  their  recognition  until  events  force  the  issue. 
The  earlier  eyidences  of  failure  in  adjustment  are  often  con- 
cealed or  overlooked,  and  yet  to  afford  the  best  chance  for 
successful  treatment,  it  is  essential  that  this  be  started  at  the 
earliest  possible  moment.  There  is,  therefore,  urgent  need  that 
the  Nation  should  provide  agencies,  free  from  every  appearance 
of  charity  or  condemnation,  for  the  early  recognition  and  treat- 
ment of  ex-service  men. 

The  following  summary  of  hospitals  and  the  nature  of 
diseases  was  secured  in  a  census  of  January  and  February,  1921. 
The  number  is  constantly  increasing,  and  does  not  include  those 
sent  to  Waukesha,  Wis.,  Marion,  Ind.,  or  other  hospitals  outside 
the  'State. 

Kankakee  State  Hospital,  Kankakee,  111. 

NAME  OP  DISEASE  NUMBER  OF  PATIENTS 

Mental  Deficiency,  2 

General  Paralysis,  1 

Manic  Depressive  1 

Other  Psychosis,  1 

Dementia  Praecox,  31 

36 
Lincoln  State  Colony  and  School,  Lincoln,  111. 

Mental  Deficiency,  1 

19 


Peoria  State  Hospital,  Peoria,  111. 

XAMi;  (IF  DISEASE 

NUMBER  OP  PATIENTS 

Other  Psychosis, 

1 

Mental  Deficiency, 

5 

Epilepsy, 

1 

Dementia  Praecox, 

12 

19 

Watertown  State  Hospital,  E.  Moline,  111. 

General  Paralysis, 

1 

Dementia  Praecox, 

6 

7 

Wilgus  Hospital,  Rockford,  111. 

Manic-Depressive  Psychosis, 

2 

Dementia  Praecox, 

1 
3 

Chicago  State  Hospital,  Dunning,  111. 

Dementia  Praecox, 

60 

General  Paralysis, 

7 

Mental  Defective, 

1 

Other  Psychosis, 

1 

69 

Jacksonville  State  Institution,  Jacksonville, 

111. 

Dementia  Praecox, 

39 

General  Paralysis, 

1 

Manic-Depressive  Psychoses, 

4 

Psycho-Neurosis, 

1 

Mental  Deficiency, 

1 

Other  Psychosis, 

1 

Epileptics, 

1 

48 

Elgin  State  Hospital,  Elgin,  111. 

Dementia  Praecox, 

87 

Mental  Defective, 

3 

General  Paralysis, 

1 

Epilepsy, 

1 

92 

Anna  State  Hospital,  Anna,  111. 

Dementia,  Praecox, 

6 

Manic  Depressive  Insanity, 

1 

7 
Marine  Hospital  No.  5  (Observation  Hospital),  Chicago,  111. 

Epilepsy,  11 

Dementia  Praecox,  1 

General  Paresis,  1 

Psycho-Neurosis,  2^ 

38 

20 


Treatment  Required — The  ex-service  niau  should  be  able  to  easily 
consult  physicians  trained  to  recognize  the  beginnings  of  such 
disorders.  These  experts  must  be  supplementary  to  and  must  not 
replace  the  general  physician  and  surgeon.  Some  specialists  are 
working  on  the  development  of  this  clinical  service  at  the  present 
time. 

Its  importance  arises  from  the  fact  that  the  patient  com- 
plains of  pains  and  discomforts,  really  of  nervous  or  mental 
origin,  which  are  apparently  connected  with  some  other  part  of 
the  body.  When  these  are  detected  at  an  early  stage  a  careful 
study  of  the  patient  is  made.  The  difficulties  which  the  patient 
is  meeting  or  failing  to  meet  will  often  disclose  the  actual  trouble 
and  will  reveal  conditions  which  can  be  remedied  by  advice  as 
to  how  thev  mav  be  adjusted  by  a  proper  change  in  the  mode 
of  life. 

Sometimes  the  situation  is  too  complex  or  there  are  evidences 
of  actual  disease.  Removal  to  a  hospital  especially  equipped 
with  every  means  known  to  science  may  be  necessary.  Here  the 
most  careful  study  should  be  made  to  determine  whether  any 
disease  exists,  and  if  so  its  nature.  Appropriate  remedies  should 
then  be  given,  if  such  are  known,  to  arrest  it  if  still  active  or  to 
remove  or  minimize  its  consequences.  Unfortunately,  our  knoAvl- 
edge  of  the  nature  and  treatment  of  many  of  these  diseases  is 
extremely  limited.  But  there  can  never  be  a  worthier  cause  nor 
a  better  opportunity  for  developing  new  knowledge  by  investi- 
gation than  is  here  presented. 

The  next  step  consists  of  training  in  ways  of  living  which 
will  secure  satisfaction  for  the  patient  without  bringing  him  into 
conflict  with  social  regulations.  Such  training  includes  not  only 
the  vocation  but  also  means  of  recreation  and  pleasure  which 
are  helpful  as  well  as  harmless. 

There  still  remains  the  further  problem  of  finding  a  sphere 
of  life  where  the  man  can  successfully  adjust  and  compete  Avith 
others,  after  the  limits  of  mental  capacitj^  have  been  determined. 
This  may  take  prolonged  study  and  educational  effort.  It  requires 
an  exceptionally  well  organized  employment  bureau  and  recrea- 
tional facilities. 

Another  feature  of  the  utmost  importance  in  the  program 
concerns  the  employment  of  social  workers  or  community  nurses 
specially  trained  for  mental  work.  They  can  assist  in  establish- 
ing the  first  contact  with  patients,  in  the  investigation  of  the 
home,  work  and  play  conditions  under  which  the  patient  has 
failed,  in  the  alleviation  of  suffering  or  distress  among  those 
dependent  upon  the  patient,  which  is  often  a  factor  in  the  break- 
down and  finally  in  supervising  and  assisting  the  patient  in  his 
rehabilitation  in  society. 

Treatment  Given — The  United  States  Public  Health  Service, 
through  the  District  Supervisor,  is  now  establishing,  at  strategic 
points  throughout  the  state,  hospitalization  units  which  will  serve 
as  consultation  centers  and  for  the  treatment  of  such  cases  as 

21 


do  not  need  hospitalization  or  have  been  returned  from  liospitals. 
This  Bureau  has  also  set  aside  the  Marine  Hospital  in  Chicago 
as  a  place  for  the  special  study  and  diagnosis  of  mental  and 
nervous  disorders.  When  the  alterations  are  completed  this  hos- 
pital will  be  well  equipped  for  the  purpose.  The  principal  dif- 
ficulty is  the  securing  of  trained  personnel,  both  medical  and 
nursing. 

In  the  state  hospitals  to  which  most  of  the  insane  are  sent 
for  hospitalization,  the  general  principle  of  treatment  is  that  laid 
down  above.  But  these  hospitals  are  all  large  and  greatly  over- 
crowded. 

Dr.  C.  F.  Read,  Superintendent  of  the  Chicago  State  Hospital 
for  the  Insane,  appeared  before  the  Appropriation  Committee  of 
the  Senate  and  House  to  ask  aid  from  that  body  in  constructing 
additional  buildings.  He  states :  "That  beds  are  so  close  together 
that  the  patients  could  hardly  get  out  on  the  side  of  their  cots." 

At  the  time  of  writing  there  200  more  patients  in  Elgin  than 
there  were  beds.     The  patients  slept  on  mattresses  on  the  floor. 

The  medical,  nursing,  occupational  and  recreational  staffs 
are  entirely  too  small  to  give  the  individual  study  and  active 
treatment,  which  are  essential  for  the  best  results.  Some  of  these 
deficiencies  have  been  partly  remedied  by  assistance  from  the 
Federal  Board  for  Vocational  Training  and  the  American  Red 
Cross,  but  the  space  available  in  buildings  is  inadequate. 

Dr.  T.  "W.  Salmon  testified  before  the  Congressional  Com- 
mittee : — ' '  I  am  not  a  lawyer  and  I  am  not  an  administrator,  but 
I  am  a  doctor,  and  for  twenty  years  I  have  devoted  mj'self  to 
the  care  of  people  suffering  with  mental  disease.  I  have  studied 
the  care  of  the  insane  in  many  States,  but  I  do  not  know  today 
any  group  of  5,000  men  suffering  from  insanit.y  Avho  are  so 
])oorly  cared  for  as  the  ex-soldiers  of  the  United  States  Army. 
I  do  not  mean  by  that,  that  all  are  equally  badly  cared  for,  but 
I  know  of  no  group  of  that;  size  that  are  allowed  to  remain  in 
unsuitable  places  week  after  week  and  month  after  month  be 
cause  there  is  a  divided  authority  on  the  part  of  those  who  are 
responsible  for  them.  So,  gentlemen,  all  I  have  to  say,  my  only 
reason  for  coming  here  as  a  doctor,  is  to  say  that  from  the 
simplest  dictates  of  humanity  it  is  necessary  to  set  up  here  in 
Washington  and  in  the  fourteen  districts  of  the  United  States  a 
real  unified  agency  that  can  reach  into  these  men's  houses,  take 
tliem  out,  and  put  them  into  Government  hospitals  established, 
built,  and  maintained  solely  for  their  benefit;  not  constructed  to 
care  for  dying,  demented  old  people,  but  to  care  for  young  men 
in  full  vigor,  who-,  nevertheless,  are  suffering  from  this  disease. 
Only  in  this  way  can  be  averted  the  dementia  that  will  even- 
tually overcome  all  these  men. 

"Unless  something  is  done  Avithin  tlie  present  year  to  im- 
prove conditions  under  which  insane  ex-service  men  arc  receiv- 
ing treatment,  hundreds  who  noAv  stand  a  fair  chance  of  being 
cured,  will  be  doomed  to  permanent  insanity, 

22 


"In  spite  of  the  fact  that  on  December  16,  1920,  5,500  ex- 
service  men  were  in  neuro-psj'cliiatric  hospitals,  tlie  Government 
has  not  spent  a.  dollar  for  the  constrnetion  of  a  sinyle  hospital 
for  the  insane  up-to-date.  Only  one-third  of  these  men  are  in 
hospitals  owned  by  the  Government.  One  of  them  is  a  converted 
reform  school  in  Koxbury,  Mass.  Another  is  a  naval  hospital 
in  Philadelphia,  Avliich  was  built  just  after  the  Civil  War.  An- 
other is  a  hotel  at  Augusta,  Ga,.,  which  has  been  used  by  a  girls' 
seminary,  and  then  has  been  turned  over  to  the  Government  and 
a  few  thousand  dollars  spent  for  partitions.  Yet  those  are 
regarded  as  special  hospitals  for  the  treatment  of  this  special 
form  of  disease." 

Dr.  Singer,  the  Director  of  the  Illinois  Psychopathic  Insti- 
tute, advises : — ' '  In  the  hospitalization  of  ex-service  men,  the 
need  of  temporary  hospitals  should  be  considered,  such  as  the 
Marine  Hospital  for  diagnostic  purposes,  and  local  clinics  for 
observation  in  connection  with  the  hospitalization  units  of  the 
United  States  Public  Health  Service.  But  the  most  important 
question  is  the  hospitalization  for  treatment  of  a  more  pro- 
longed kind. 

"(a)  Psycho-neuroses  should  be  hospitalized  only 
for  a  short  time  or  not  at  all.  The  great  thing  here  is  the 
development  of  morale  and  confidence  and  the  avoidance 
of  anj'thing  which  would  tend  to  confirm  a  feeling  of 
invalidism. 

"(b)  Psychoses  (or  insanity),  demands  hospitals 
specially  planned  with  reception  service  for  intensive 
study,  hospital  wards  for  bodily  illness,  specially 
equipped  pavilions  for  disturbed  and  excited  patients, 
educational  facilities  and  means  for  recreation,  con- 
valescent departments. 

"These  hospitals  should  belong  to  the  Government 
and  be  limited  to  ex-service  men.  These  should  set 
national  standards  for  constructive  treatment  and  no 
such  case  should  be  considered  as  merely  custodial. 
Large  personnel  necessary  to  permit  individualization. 
Illinois'  quota  at  the  peak  of  the  load  would  amount  to 
between  six  hundred  and  a  thousand  cases. 

•  "(c)  Epilepsy  needs  special  grouping.  There  are 
about  twenty-five  cases  of  epilepsy  now  in  hospitals  of 
Illinois,  and  it  is  estimated  that  there  are  five  hundred 
outside  in  the  state.  They  are  a  special  problem.  The 
nature  of  their  trouble  prevents  them  from  being  re- 
liable in  employment.  The  only  solution  seems  to  be 
to  find  a  special  friend  or  relative  who  will  assure  the 
epileptic  continued  employment,  in  spite  of  his  affliction, 
and  then  give  tlie  man  such  training  as  Avill  make  him 
valuable  as  an  employee.  Compensation  should  be 
awarded  on  a  temporary  total  basis,  which  would  assist 
the  men  in  being  cared  for  in  their  homes." 

23 


Dr.  Salmon  empliasizes  this  conclusion: — "Certain  important 
factors  are  on  tlie  side  of  these  ex-soldiers.  They  are  young  and, 
for  the  most  part,  in  excellent  bodily  condition.  Thoy  have  what 
is  denied  most  of  the  insane — an  opportunity  to  leave  hospitals 
partially  well  and  yet,  with  monetary  aid,  to  live  happy,  con- 
tentfed  and  moderately  useful  lives.  Their  social  rehabilitation  is 
not,  fortunately,  dependent  upon  a  100  per  cent  economic  re- 
habilitation for,  whatever  the  Government  has  failed  to  do,  it  is 
ready  to  compensate  and  to  train  vocationally  those  men  who 
have  had  their  earning  capacity  impaired  bj^  mental  illness  and 
thus  enable  them  to  compete,  if  not  on  equal  terms,  upon  fairly 
satLsfactory  terms,  Avith  their  fellow-men." 

There  was  never,  in  the  whole  history  of  mental  medicine, 
such  an  opportunity  as  this  for  showing  what  can  be  accom- 
plished by  re-education  in  the  justly  dreaded  mental  disease  that 
constitutes  the  chief  problem  in  the  care  of  mentally  disabled 
ex-service  men. 

Beginning  with  occupational  tlierapy  carried  on  by  nurses 
and  occupation  aides  in  the  wards  and  even  at  the  bedsides  in 
these  hospitals,  vocational  education  can  .be  employed  at  the 
earliest  possible  moment  when  resumption  of  activity  and  in- 
terest justifies  it.  This  training  can  be  directed  by  those  expert 
in  abnormal  psychology  and  carried  on  under  the  Federal  Board 
for  Vocational  Education,  by  teachers  who  even  now  can  be 
trained  for  the  very  dilificult  and  special  work  which  they  will 
have  to  do  in  behalf  of  mental  patients. 

Through  a  system  of  psychia,tric  social  service  and  Govern- 
ment dispensaries,  it  will  be  possible  to  contijiue  skilled  super- 
vision and  direction  of  these  men  for  months  or  years  after  they 
have  left  the  shelter  of  neuro-psychiatric  hospitals.  It  is  believed 
by  those  most  familiar  with  the  proTjlem  that  not  less  than  half 
the  ex-soldiers  suffering  from  this  especially  malignant  type  of 
mental  disease  can  be  economically  and  socially  restored  under 
such'  unusually  favorable   conditions. 

All  these  things  depend,  however,  first,  upon  quick  and 
favorable  action  by  the  Appropriations  Committee  of  Congress; 
second,  upon  the  establishment  within  the  Public  Health  Service 
of  an  efficient  neuro-psychiatric  service,  headed  by  men  of  long 
experience  in  dealing  with  the  intricate  problems  that  fall  to  the 
neuro-psychiatrist  and,  third,  upon  co-operation  between  hos- 
pitals, psychiatric  social  service  workers  and  committee  agencies 
to  ensure  the  after-care  and  community  supervision  that  form 
such  an  essential  part  of  dealing  successfully  with  the  lifetime 
problem  presented  by  most  forms  of  mental  diseases." 

24 


SOME  SIGNIFICANT  MENTAL  CASES  FROM  THE  FILES  OF 
THE  CHICAGO  RED  CROSS 

Case  1.  March  18,  1921. 

Mr.  X  enlisted  in  the  United  States  Army  August  5,  1915  and 
M-as  discharged  July  26,  1919,  S.  C.  D.  4th  Ind.  H.  C.  D.,  Chicago, 
Illinois,  July  18,  1919.  Served  overseas  and  was  gassed.  Was 
cited  by  General  Pershing  and  by  the  French  Government. 

He  enlisted  in  the  Navy,  October  2,  1919,  at  Chicago  and  was 
discharged  December  6,  1919,  as  an  "undesirable."  Subsequently 
enlisted  in  the  Marine  Corps  and  was  discharged  June  10,  1920, 
"by  reason  of  physical  disability." 

Mr.  X  has  been  under  hospitalization  on  several  different 
occasions  and  in  various  hospitals  including  Hospital  No.  34,  East 
Norfolk,  Fort  Sheridan  General  Hospital  No.  28,  United  States 
Navy  Hospital,  Mare  Island,  California,  State  Hospital,  Stokholm, 
California,  United  States  Public  Health  Service  Hospital  No.  30, 
Chicago  Psychopathic  Hospital  and  finally  Chicago  State  Hos- 
pital, Dunning,  Illinois.  He  was  committed  to  Dunning  from 
Psychopathic  Hospital,  September  30,  1920.  Diagnosis:  Manic 
reaction. 

A  report  from  Chicago  State  Hospital,  November  8,  states 
that  X  was  suffering  from  Catatonic  Excitement.  Was  very  rest- 
less and  noisy.  While  under  observation  did  not  eat  well  and  on 
account  of  his  constant  excitement,  exhausted  himself.  Mr.  X  had 
been  reared  by  an  aunt,  and  she  removed  him  from  Dunning  about 
November  1,  1920,  because  of  the  prejudices  she  held  against 
Dunning.  Mr.  X  was  to  be  transferred  to  the  Elgin  State  Hospital, 
but  his  aunt  would  not  listen  to  this  as  she  maintains  that  all 
State  Hospitals  are  alike,  and  that  he  would  receive  no  better 
treatment  at  Elgin  than  elsewhere. .  She  is  therefore  keeping  him 
at  home  with  her,  where  the  conditions  are  most  abominable.  Her 
own  mental  condition  seems  to  be  none  too  sound.  She  is  very 
irritable  and  easily  excited  and  quite  filthy  minded.  She  main- 
tains a  rooming  house,  which  in  the  past  has  had  a  questionable 
reputation  and  the  room  in  which  Mr.  X  is  kept  is  dirty,  poorly 
lighted  and  ventilated,  and  in  addition  this  room  serves  as  a  bed- 
room for  Miss  0  herself  and  one  of  her  men  roomers,  an  ignorant 
type  of  person,  whom  she  states  she  is  employing  to  assist  her  in 
caring  for  Mr.  X.  Patient  is  usually  strapped  to  his  bed  on 
account  of  his  excited  state.  Miss  0  keeps  him  constantly  in  a 
sort  of  harness  w^hich  prevents  him  from  doing  any  undue  violence, 
but  even  with  this  contrivance  she  keeps  very  close  watch  of  him. 

Indeed  the  conditions  here  are  such  as  would  unbalance  the 
mental  state  of  a  healthy  person  if  he  were  compelled  to  submit 
to  them  very  long,  but  these  conditions  cannot  be  remedied  because 
of  the  horror  Miss  0  has  for  the  State  Institution  on  account  of 
her  opinion  of  X  's  treatment  there  and  because  there  is  no  Govern- 
ment Hospital  to  care  for  this  discharged  soldier  and  give  him 
the  care  he  is  so  greatly  in  need  of. 

25 


Case  2.  j^^^^^l^  17^  1921. 

]Mr.  Klaiik,  in  June  1018,  at  the  a^'o  of  23  years,  entered  the 
World  War  Serviee.  He  h^ft  a  very  good  position  where  lie  Avas 
in  partnership  with  his  brother.  While  at  eanip,  during  the  early 
days  of  his  training,  lie  received  a  severe  head  injury  and  after 
several  months  at  the  Camp  Hospital,  he  was  discharged  on  a 
Certificate  of  Disability,  because  of  mental  trouble. 

For  two  years,  Mr.  Blank  has  lived  at  home  and  has  been 
supported  by  his  family.  He  has  been  unable  to  perform  any  kind 
of  work.  He  is  not  able  to  travel  without  an  escort  and  his  presence 
at  his  brother's  firm  causes  commotion  and  a  decrease  in  business. 

Mr.  Blank  has  rational  times  and  is  perfectly  aware  of  his 
disability.  The  entire  family  feel  keeiil.y  his  affliction  and  are 
reticent  regarding  his  ])ehavior.  We  finally  persuaded  the  family, 
in  September  of  1920,  to  file  claim  for  compensation  for  Mr.  Blank 
and  lately  an  award  of  compensation  of  $16.00  per  month  was  made. 
The  boy  is  gradually  becoming  worse.  On  several  occasions  he  has 
attempted  suicide,  liut  the  family  still  struggle  along.  They  are 
unwilling  to  institutionalize  him,  seeing  the  only  means  to  do  so 
thru  court  action  and  a  State  Institution.  They  feel  keenly  the 
stigma  of  "County"  procedure.  The  family  would  be  willing  to 
have  him  enter  an  institution,  if  the  entire  matter  could  be  con- 
trolled by  the  Government. 

Case  3.  ^^^^.^,1^  ^7^  2921. 

On  September  20,  1918,  the  mother  of  John  D.  asked  our 
a.ssistance  in  securing  an  unpaid  allotment  made  to  her  bj^  her 
son.  When  questioned  as  to  the  Avhereabouts  of  her  son,  it  was 
learned  that  he  was  suffering  from  mental  trouble  and  under 
close  surveillance  of  the  family.  Although  he  had  received  a 
disabilit}'  discharge,  the  mother  refused  to  file  a  compensation  claim 
because  she  feared  this  step  would  mean  hospitalization  in  a  State 
Institution. 

In  November,  1919,  over  a  year  from  the  date  of  his  discharge, 
John  escaped  from  the  home  and  appeared  at  the  army  recruiting 
station.  His  strange  actions  there  caused  the  army  officers  to  take 
him  directly  to  a  Public  Health  Service  Hospital.  W^hile  at  the 
latter  place  his  claim  for  compensation  Avas  sent  thru,  the  mother 
being  willing  because  he  was  at  that  time  in  a  government  hospital. 
Later  he  was  committed  to  a  State  Institution. 

For  over  a  year  this  young  man  was  without  proper  medical 
attention  because  the  government  had  no  institution  for  discharged 
soldiers  suffering  with  mental  trouble. 

General  Medical  and  Surgical  Care 

Medical  and  Surgical  care  of  sick  and  disabled  ex-service 
men  covers  the  entire  field  of  medicine.  During  the  war  the 
medical  service  of  the  country  was  mobilized  to  this  end.  After 
the  Armistice,  many  leading  ])hysicians  reniaiiied  for  reeonsti-uc- 

26 


tioii  work.  The  local  Public  Health  Service  still  has  as  their 
consultants,  leaders  of  medicine  from  this  district.  The  splendid 
work  of  these  consulting  specialists,  Avho  have  unsparingly 
devoted  their  time  and  service  in  many  difficult  cases,  deserves 
high  praise.  They  did  not  work  for  compensation  as  the  fees 
were  small,  but  took  the  attitude  that  nothing  was  too  good  for 
the  disabled  ex-service  man.  These  specialists — the  best  in  their 
profession,  deserve  much  better  appreciation  than  can  be  given 
them  in  the  narrow  field  of  this  report. 

The  general  medical  and  surgical  care  of  ex-service  men  has 
been  uniformh"  good.  It  covers  a  very  wide  field,  including  all  those 
who  are  patients  of  the  AVar  Risk  Bureau  and  there  have  been  few 
complaints. 

The  turn-over  in  this  field  is  \evy  great — the  number,  for 
instance,  in  the  47th  Street  Hospital,  Public  Health  Service  No. 
30,  is  approximately  500.  They  are  received  and  discharged  so 
rapidlj^  that  it  is  estimated  that  the  average  stay  is  about  four 
weeks.  Other  hospitals  Avith  a  smaller  number  of  beds  are  used 
for  more  chronic  cases. 

The  following  hospitals  were  used  throughout  the  state  for 
hospital  care : 

General  Medical  Cases 

U.S.P.H.  Service  Hospital  No.  30,  Chicago,  232 
U.S.P.H.  Service  Hospital  No.  53,  Dwight,    100 

Contract  Hospitals 

BrokaAV  Hospital,  Bloomington,  1 

St.  Mary's  Hospital,  Cairo,  10 

St.  Mary's  Hospital,  Centralia,  2 

St.  Paul's  Hospital,  Chicago,  5 

Auburn  Park  Hospital,  Chicago,  35 

Bremerman  Hospital,  Chicago,  35 

Jackson  Park  Hospital,  Chicago,  27 

St.  Elizabeth's  Hospital,  Danville,  4 
Decatur  Mason  Countj^  Hospital,  Decatur,         1 

St.  Mary's  Hospital,  Decatur,  1 

St.  Mary's  Hospital,  E.  St.  Louis,  14 

Sherman  Hospital,  Elgin,  14 

Galesburg's  Cottage  Hospital,  Galesburg,  1 

Holmes  Hospital,  Macomb,  14 

Wallbright  Hospital,  Metropolis,  2 
Methodist  Hospital  of  Central  Illinois,  Peoria,    9 

St.  Francis  Hospital,  Peoria,  1 

St.  Mary's  Hospital,  Quincj',  4 

Robinson  Hospital,  Robinson,  3 

Springfield  Hospital,   Springfield,  7 

St.  Anthony's  Hospital,  Rock  Island,  6 

St.  Mary's  Hospital,  Streator,  2 

St.  John's  Hospital,  Springfield,  3 

27 


Every  patient  in  these  hospitals  was  visited  by  Mr.  Lyden  in 
the  course  of  his  census.  The  number  in  tlie  hospitals  varies.  New 
hospitals  are  added  and  the  patients  withdrawn  for  others  each 
month.  The  U.S.P.H.  Service  Hospital  No.  30  on  Drexel  Blvd., 
at  the  time  of  writing  has  over  500  patients,  and  the  hospital  at 
Dwight  is  making  arrangements  to  care  for  more  than  250. 

"I  enjoyed  talking  with  all  the  men,"  said  Mr.  Lyden.  ''The 
medical  and  surgical  cases  are  always  more  contented  than  the 
others.  They  see  a  speedy  prospect  of  recovery.  The  men  down 
state,  particularly,  wanted  to  be  in  a  home  hospital.  They  told 
me  that  the  food,  the  medical  treatment  and  the  general  con- 
ditions were  good.  All  of  these  hospitals  are  old  established  hos- 
pitals and  are  known  to  the  boys  and  their  relatives." 

One  young  ex-service  man  in  Metropolis  expressed  the  attitude 
of  the  men  tOAvard  this  group  of  hospitals  when  asked  if  he  wanted 
to  be  transferred  to  Chicago.  "This  is  our  hospital.  It  is  our 
town  and  we  Avant  to  be  near  our  folks.  Visits  from  them  would 
be  out  of  the  question  if  we  Avere  transferred  very  far  from  here. 
I  Avant  to  staj'  here." 

The  policy  of  using  local  hospitals  for  medical  care  AA'hen  that 
care  can  be  guaranteed  and  inspected  has  many  advantages,  both 
in  sentiment,  in  service  and  economy. 

The  Public  Health  Service  treats  as  medical  and  surgical  cases, 
all  claimants  of  the  War  Kisk  Insurance  AA^ho  have  been  gi\^en  ten 
per  cent  or  more  disabilitA',  or  claimants  AA'ho,  because  of  physical 
trouble,  caused  by  or  aggravated  by  army  service,  are  Avaiting  for 
the  decision  of  the  War  Risk  Bureau. 

BUREAU  OF  WAR  RISK  INSURANCE 

The  Bureau  of  War  Risk  Insurance  Avhich  Avas  created  in  19J.4 
and  Avhose  Avork  Avas  enlarged  and  extended  by  legislation  en- 
acted in  1916  and  1917,  had  the  responsibility  of  organizing  four 
distinct  projects — Marine  and  Seamen's  insurance,  allotments  of 
pay  and  family  alloAvances,  Military  and  Naval  insurance,  and 
the  payment  of  compensation  on  account  of  death  and  disability 
incurred  in  the  Militarj^  or  NaA^al  service  during  the  present  Avar. 
Under  the  act  defining  the  present  functions,  CA'ery  sick  or  dis- 
abled man  entitled  to  treatment,  compensation  or  training  is 
technically  a  Avard  of  this  Bureau,  although  his  actual  treatment 
or  training  is  carried  on  by  other  agencies. 

Tliere  are  tAvo  functions  Avhich  are  of  A^tal  importance — one, 
tiie  payment  of  compensation — the  other,  the  providing  of  insur- 
ance for  dependents. 

Compensation — The  exact  situation  Avith  reference  to  compensa- 
tion is  shown  in  the  analysis  of  the  census.  It  shoAvs  claims 
])ending,  claims  that  need  adjusting  and  claims  satisfactorily 
adjusted.  It  Avas  impossible  to  get  the  information  from  the 
mental  hospitals.  In  every  case,  as  soon  as  Mr.  Lyden  Avas 
informed   that   compensation    AA'as   not   adjusted,    the   facts   Avere 

28 


sent  directly  to  Mr.  E.  V.  Dickson,  the  Local  Representative  of 
the  War  Risk  Bureau  and  to  the  Service  Department  of  the 
American  Legion.  Mr,  Dickson  states — "that  584  cases  had  been 
sent  him  as  a  result  of  the  census  which  he  did  not  have  in  his 
files."    A  sta.tement  of  the  situation  follows: 


COMPENSATION 

General  Medical  Cases 


CLAIMS     UNAD- 


AD- 


HOSPITALS 

St.  Mary's, 

Brokaw, 

Auburn  Park, 

U.S.P.H.S.  No.  30, 

St.  Paul's, 

St.  Mary's, 

St.  Elizabeth's, 

U.S.P.H.  No.  53, 

Decatur,  Mason  Co. 

St.  Mary's, 

Sherman, 

St.  Mary's, 

Holmes, 

Wallbright, 

Methodist  of  Central  111. 

St.  Francis, 

Rockford, 

St.  Anthony's, 

Springfield, 

St.  John's, 

Jackson  Park, 

Cook  County  T.B.,     * 

Municipal  T.B.  San., 

Fairview  McLean, 


LOCATION  PENDING  JUSTED  JUSTED 


Cairo,  3 

Bloomington,  — 

Chicago, 

Chicago, 

Chicago, 

Centralia, 

Danville, 

Dwight, 


Decatur, 

Elgin, 

E.  St.  Louis, 

Macomb, 

Metropolis, 

Peoria, 

Peoria, 

Rockford, 

Rock  Island, 

Springfield, 

Springfield, 

Chicago, 

Oak  Forest, 

Chica.go, 

Chicago, 


19 
125 

2 

3 

3 

21 

1 
9 
11 
6 
1 
4 
1 
2 

7 

2 

15 

47 

26 

7 


1 
70 
3 
1 
1 
19 

1 
3 

5 
1 


9 

12 

1 

1 


2 
1 
5 
34 
1 


52 


Tubercular  Cases 


CLAIMS     UNAD- 


4 

25 

12 

5 


AD- 


HOSPITALS 

Edward 's  Sanitarium, 
La  Salle  County, 
Ottawa  T.B.  Colony, 
Peoria  Municipal  Sanitarium, 
Palmer  T.B.  Sanitarium, 
Rock  Island  M.T.B., 
Adams  County, 
Chicago  Fresh  Air, 


LOCATION  PENDING  JUSTED  JUSTED 


Naperville, 

Ottawa, 

Ottawa, 

Peoria, 

Springfield, 

Rock  Island, 

Quincy, 

Chicago, 


Chicago  Winfield  Sanitarium,    Winfield, 


3 

4 
6 

15 


In  many  of  these  claims,  particularly  in  the  Mental  Hospitals, 
great   difficulty  in  securing   proper   compensation   has  been   due 

29 


to  tlie  iiatiu'c  of  the  disease  and  the  establishment  of  its  definite 
connection  with  the  service.  A  plan  has  been  worked  out  in  Illi- 
nois, by  Mr.  Hartman,  A.ssistant  Director  of  the  Service  Depart- 
ment, whereby  the  clerks  of  county  courts  co-operate  with  the 
American  Legion  in  filing  the  necessary  papers  and  securing  the 
proper  aiifidavits. 

The  principal  reasons  for  delay  in  adju.sting  claims  of  men 
in  hospitals  are : 

1.  Rapid  turnover  prevents  agency  handling  claims 
from  obtaining  action  from  Washington  before  the  man 
leaves  the  hospital. 

2.  lusufificient  evidence  to  connect  the  man's  dis- 
ability M'ith  his  service. 

3.  Lack  of  workers  by  agencies  handling  claims. 

4.  Lack  of  co-operation  between  agencies  handling 
claims. 

The  normal  method  of  filling  an  original  claim  for  com- 
pensation is  for  the  applicant  to  first  fill  out  two  forms,  an  appli- 
cation for  compensation  and  a  sta,tement  regarding  his  occupation, 
which,  together  with  a  certified  cop,y  of  his  discharge,  is  taken  to 
the  nearest  Public  Health  Service  physician,  where  an  examina- 
tion, together  with  the  three  papers  above  mentioned,  is  then  for- 
warded through  the  U.  S.  Public  Health  Service  to  the  Bureau  of 
War  Risk  Insurance. 

Decentralization  of  tlie  Bureau  of  War  Risk  Insurance  will 
be  of  great  benefit,  according  to  Mr.  Dickson,  to  men  in  hospitals, 
for  the  foUoAving  reasons : 

1.  It  will  be  possible  to  establish  personal  contact 
betAveen  the  awarding  office  and  the  claimant,  something 
W'hich  is  practically  impossible  under  the  present  system. 

2.  Expedited  action  can  be  given  to  practically 
every  case  owing  to  the  fact  that  there  will  be  propor- 
tionately a  very  much  smaller  volume  of  business  being 

^handled  than  in  one  office  in  Washington. 

3.  In  the  event  of  an  award  not  being  satisfactory 
to  the  claimant,  it  will  be  an  easy  matter  for  the 
claimant  to  either  Avrite  or  call  at  the  awarding  office 
and  either  have  a  satisfactory  adjustment  made  or  be 
furnished  with  the  information  as  to  what  would  be 
required  to  complete  his  case. 

4.  A  great  deal  of  the  dissatisfaction  with  the  pres- 
ent sj^stem  of  handling  awards  is  due  to  the  long  lapse 
of  time — first,  in  having  an  award  made  and — second,  in 
the  event  of  any  trouble,  of  having  adjustment  made. 
Practically  all  of  this  will  be  done  aAvay  with  with  the 
decentralization  of  tlie  Bureau,  as  check  being  made 
out  in  the  regional  offices  will  insure  prompt  action  upon 
not  only  the  original  award  but  also  upon  readjustment. 

30 


Insurance — The  insurance  situation  as  far  as  sick  and  disabled 
men  in  Illinois  hospitals  are  concerned,  is  most  unsatisfactory 
as  the  following  facts  show: 

HOSPITAL  NO  INSURANCE      INSURANCE  IN  FORCE 

Auburn  Park  Hospital,  Chicago,  32  3 

U.S.P.H.S.  Hospital  No.  30,  Chicago,  197  38 

Cook  Co.  T.B.  Sanitarium,  Chicago,    64  16 

These  men  had  every  reason  to  keep  up  insurance,  but  lacked 
resources.  Many  of  them  allowed  their  insurance  to  lapse  because 
they  did  not  have  the  money.  Many  of  them  did  not  have  the 
monej^  because  they  were  incapacitated  for  work  and  had  not 
received  adequate  compensation.  The  premium  often  ran  as  high 
as  $7.00  per  month,  while  at  best  they  were  only  receiving  from 
$8.00  to  $30.00  from  the  Government,  and  frequently  nothing. 

Before  the  Government  finally  got  around  to  paying  adequate 
compensation,  the  insurance  had  lapsed,  and  when  the  sick  and 
disabled  ex-service  men  tried  to  restore  their  insurance,  as  healthy, 
uninjured  men  were  being  solicited  to  do,  they  found  an  iron-clad 
ruling  that  no  man  could  restore  his  insurance  unless  he  was  physi- 
eally  fit.  In  other  words,  the  Government  got  the  sick  and  disabled 
''coming  and  going."  When  they  could  retain  insurance  secured 
in  service  to  protect  dependents,  they  couldn't  because  the  Govern- 
ment had  neglected  to  pay  them  compensation,  but  when  they  could 
pay,  they  were  not  allowed  to  because  the  Government  had  decided 
to  play  safe. 

The  matter  was  taken  up  with  R.  G.  Cholmeley-Jones,  Director, 
as  a  result  of  the  census.  He  stated  on  February  24th,  "that  the 
suggestion  of  a  ruling  on  this  matter  possessed  great  worth,  and 
that  he  had  given  careful  study  relative  to  the  promulgation  of  a 
regulation  concerning  the  reinstatement  of  lapsed  insurance  where 
an  insured  was  unable  to  reinstate  his  insurance  because  of  the 
aggravation  of  a  war  disability.  You  may  rest  assured  that  this 
matter  will  receive  affirmative  action  in  the  course  of  the  next  few 
days. ' '  If  this  can  be  corrected  it  will  clear  up  an  unfair  situation 
both  for  the  insured'  and  for  those  who  are  dependent  upon  them. 
Mr.  Cholmeley-Jones  has  since  resigned  and  up  to  the  time  of 
writing  this  report  no  such  action  has  been  taken. 

When,  the  Regional  Offices  of  the  Bureau  of  War  Bisk  Insur- 
ance are  vested  with  full  authority  to  settle  claims,  adjust  awards 
and  issue  checks  to  those  men  justly  entitled  to  them,  95  per  cent 
of  the  present  complaints  directed  at  present  against  this  hureau 
will  be  cleared  'up  immediately  and  all  claims  of  merit  will  receive 
immediate  action.  Congress  can  give  the  Bureau  this  power  to 
decentralize.  The  responsible  local  head  must  have  the  power  to 
act. 

31 


THE  UNITED  STATES  PUBLIC  HEALTH  SERVICE 

Tlie  Public  Health  Sen-vice  is  an  ancient  institution  of  tlic 
Treasury  J)cpai'tnient,  where  it  has  been  located  from  the  date  of 
its  creation.  It  had  its  origin  in  tiie  old  Marine  Hospital  Service, 
which  was  authorized  by  an  Act  of  Congress  in  1798.  In  1902  its 
name  was  changed  to  the  Public  Health  and  Marine  Hospital 
Service  and  by  the  Act  approved  August  14,  1912,  it  became  known 
as  the  Public  Health  Service. 

During  its  life  of  122  years,  the  service  has  grown  from  a 
small  institution,  designed  to  furnish  medical  care  to  the  sick  and 
disabled  seamen  of  the  American  Merchant  Marine,  to  a  great 
national  health  agency,  operating  the  maritime  quarantine  stations, 
protecting  the  country  against  foreign  epidemics,  preventing  the 
interstate  spread  of  disease,  co-operating  with  state  and  local  health 
authorities  in  the  control  of  sickness. 

The  care  of  patients  of  the  Bureau  of  War  Risk  Insurance 
was  delegated  to  the  United  States  Public  Health  Service  under 
Public  Act  No.  326,  which  provided  for  the  furnishing  of  hospital 
and  sanitarium  facilities  by  the  Secretary  of  the  Treasury  appro- 
priating a  sum  of  money  for  each  purpose  and  turning  over  to 
the  Secretary  certain  Army  Base  Hospitals.  This  so  increased  the 
already  existing  functions  of  the  Hospital  Division  of  the  Public 
Health  Service  that  early  in  May,  1919,  it  was  decided  to  decen- 
tralize into  fourteen  districts.  This  decentralization  w'as  begun  the 
latter  part  of  May  and  early  in  June,  1919,  and  the  functions  of 
the  district  offices  grew  with  tremendous  rapidity. 

The  Eighth  District  is  the  second  largest  of  these  Districts, 
and  comprises  the  states  of  Illinois,  Wisconsin  and  Michigan  and 
has  Headquarters  located  in  Chicago.  Dr.  W.  C.  Witte  is  the 
District  Supervisor. 

The  main  functions  of  the  district  office  can  be  divided  into 
five  factors;  namely: 

1.  The  procuring  of  examinations  and  furnishing  of 
reports  of  the  same  to  the  Bureau  of  War  Risk  Insurance 
and  the  Federal  Board  for  Vocational  Education.  In  this 
connection  it  might  be  added  that  these  reports  are  fur- 
nished to  both  these  bureaus  simultaneously. 

2.  The  providing  of  relief  to  compensable  claimants 
of  the  Bureau  of  War  Risk  Insurance  and  Trainees  of 
the  Federal  Board. 

3.  Tiie  keeping  of  records. 

4.  The  preparation  and  certification  of  vouchers  to 
cover  payment  for  services  rendei-ed. 

5.  The  supervision  of  property  and  personnel. 

32 


To  carry  on  the  administrative  details  of  this  organization, 
there  are  on  duty  at  Headqnarters  of  the  Eighth  District,  260  non- 
medical personnel,  including  three  nnrses  and  one  dental  me- 
chanic, 45  medical  officers,  8  of  whom  are  assigned  for  special 
duty  with  the  Federal  Board.  The  district  field  work  is  handled 
by  means  of  officers  and  specially  designated  physicians  and  at- 
tending specialists,  located  at  the  various  points  of  the  District,  it 
being  desired  to  have  a  representative  in  every  county.  There  are 
at  present  on  duty  in  the  Eighth  District,  126  Acting  Assistant 
Surgeons  (officers),  147  Designated  Physicians  and  87  Attending 
Specialists. 

It  is  possible  with  this  organization  to  provide  service  to  claim- 
ants promptly  and,  if  necessary,  in  their  own  community.  It  is 
the  express  desire  of  the  Director  of  the  Bureau  of  War  Risk  In- 
surance that  beds  in  Government  owned  and  operated  hospitals 
be  utilized  to  the  fullest  extent.  However,  because  of  the  scarcity 
of  such  beds  it  has  been  necessary  to  make  arrangements  with 
private  hospitals  for  the  care  of  these  patients  by  means  of  con- 
tracts. In  the  Eighth  District  there  are  213  such  institutions 
being  used.  In  this  connection,  it  might  be  noted  that  the  Service 
anticipated  this  urgent  need  for  beds,  and  submitted  to  Congress 
an  estimate  calling  for  the  building  of  sufficient  hospitals  to  provide 
for  the  increasing  number  of  cases  needing  care.  However,  this 
was  not  granted  and  it  became  necessary  to  lease  certain  buildings 
and  reconstruct  them  for  their  use.  In  the  Eighth  District  there 
are  approximately  2600  cases  in  hospitals,  more  than  half  of  which 
are  in  contract  hospitals. 

One  of  the  serious  problems  of  the  Public  Health  Service  is 
the  salary  restrictions  placed  by  Congress  upon  it.  It  is  almost 
impossible  for  them  to  secure  an  adequate,  permanent  medical  and 
surgical  personnel  at  the  salaries  now  authorized.  In  a  report 
from  the  Surgeon-General,  it  was  stated  that  ''there  were  more 
resignations  from  the  Public  Health  Service  during  the  last  year 
than  there  were  appointments."  The  chief  reason  for  this  is  that 
the  majority  of  their  physicians,  particularly  those  who  have  a 
background  of  real  experience,  cannot  afford  to  work  for  the 
Government  in  this  department  at  the  salaries  which  Congress 
has  authorized.  Many  of  those  who  do  remain  are  compelled  to 
do  so  at  a  great  personal  sacrifice. 

While  it  is  important  that  the  Oovernment  should  huild  and 
maintain  proper  hospitals  for  sick  and  disahled  ex-service  men, 
it  is  equally  important  that  the  department  responsible  for  their 
medical  and  surgical  care  shoidd  he  in  a  position  to  employ  and 
adequately  pay  the  best  men  wlio  can  be  secured  for  special 
service. 

33 


FEDERAL  BOARD  FOR  VOCATIONAL  EDUCATION 

TIr'  Fedi'i-al  lioarcl  for  Vocational  Ecliu-alioii  is  a  govenimeiii 
agency  organized  to  retrain  or  re-edncate  ex-service  men  who  have 
become  disal)lcd  thru  their  military  or  naval  service.  It  is  the 
Board's  duty  to  take  a  disabled  man  and  to  give  him  the  sort  of 
training  that  Avill  make  it  possible  for  him  to  be  independent  in 
spite  of  his  disability.  The  Board  is  required  to  plan  the  man's 
training  so  that  after  the  work  is  completed  its  employment  de- 
partment can  secure  for  him  a  position  that  will  make  a  good 
living  for  himself  and  family,  a  preservation  of  his  self-respect  and 
financial  independence  for  the  rest  of  his  life. 

"There  are  approximate!}^  4000  disabled  ex-service  men," 
Mr.  Charles  W.  Sylvester,  Divisional  Vocational  Officer,  reports, 
"taking  training  under  the  Board  of  Vocational  Education  in  the 
State  of  Illinois. ' '  3000  are  in  Chicago.  The  majority  are  in  edu- 
cational institutions,  some  are  in  factories,  offices,  business  houses, 
railroads,  but  because  of  the  wide  distribution  of  the  hospitals, 
the  training  work  is  only  done  in  hospitals  which  have  more  than 
25  ex-service  men  as  patients.  Preliminary  fundamental  training, 
such  as  English,  Mathematics,  Typewriting,  etc.  is  chietly  given 
during  this  period.  It  is  used  largely  as  a  period  to  discover  along 
what  lines  vocational  education  should  be  given. 

In  the  State  of  Illinois,  such  schools  as  the  University  of 
Illinois,  Chicago  Universit}',  Northwestern  University,  Kent  Col- 
lege of  Law,  Armour  Institute,  Academy  of  Commercial  Art — the 
various  high  grade  musical  schools,  Lewis  Institute  and  the  AVash- 
burne  School  are  among  those  with  whom  the  Board  has  con- 
tracted to  furnish  training. 

The  men  receive  from  $100  to  $170  per  month  while  they  are 
taking  the  worjc,  the  exact  amount  depending  upon  the  number 
of  dependents  each  man  has.  After  they  have  finished  their  courses 
of  training,  employment  is  secured  by  the  Federal  Board  and 
followed  up  until  such  a  time  as  the  Board  realizes  they  have 
successfully  completed  their  training  and  are  rehabilitated  to  the 
point  where  they  need  no  further  assistance. 

All  types  of  training  are  given  the  men,  this  ranging  from 
shoemaking  thru  the  other  various  different  lines  of  work,  up  to 
and  including  such  courses  as  law,  medicine  and  pedagogy.  The 
various  disabilities  that  the  men  have  range  from  systematic  dis- 
eases, such  as  tuberculosis,  heart  trouble,  etc.  to  those  suffering 
with  loss  of  limbs,  sight  or  hearing.  Each  case  presents  an  indi- 
vidual problem  and  no  two  of  them  are  alike.  It  is  difficult  to 
say  when  the  peak  of  this  load  will  be  reached  in  this  District 
and  in  this  State,  but  it  probably  will  not  come  for  at  least  two 

34 


or  three  years.  This  is  due  to  the  fact  that  a  great  many  men 
remain  in  the  hospitals  and  that  a  great  many  men  are  discon- 
tinued during  their  courses  due  to  their  physical  inabilitj^  to 
continue  their  work. 

At  the  present  time,  there  are  at  least  several  hundred  men 
in  the  State  of  Illinois  who  have  been  approved  for  the  full  benefits 
of  the  Act  but  whose  physical  condition  will  not  permit  their 
entrance  into  training.  There  are  also  as  many  as  2000  men  in 
the  State  of  Illinois  wjio  have  been  approved  for  training  under 
Section  2  of  the  Act  and  who  have  not  accepted  same,  probably 
due  to  an  ignorance  of  what  is  being  done.  The  number  of  men 
who  are  being  made  eligible  for  training  is  increasing  day  by  day, 
and  if  some  of  the  Legislation  which  is  now  before  Congress  is 
enacted  the  number  of  men  eligible  for  training  in  the  State  of 
Illinois  will  at  least  be  trebled.  It  is  believed  that  the  present 
facilities  at  the  disposal  of  the  Federal  Board  in  this  District  offer 
to  the  men  in  this  District  the  greatest  and  most  generous  oppor- 
tunity that  any  country  has  ever  offered  to  its  disabled  men. 

During  1920  the  Federal  Board  in  the  8th  District  came  in 
contact  with  several  hundred  men  who  had  been  discharged  from 
hospitals  and  sanitoriums  as  cured  from  tuberculosis,  but  who, 
on  account  of  their  weakened  physical  condition,  could  not  enter 
the  regular  vocational  training  classes.  There  was  an  immediate 
need  for  training  under  medical  supervision  and  in  such  quantity 
as  the  particular  man  could  take  with  safety. 

After  searching  the  district  for  a  suitable  location,  a  school  at 
Nauvoo,  Illinois,  on  the  bluffs  of  the  Mississippi  River,  which  would 
accommodate  150  of  these  men  at  a  time,  was  selected. 

A  comprehensive  plan  for  the  rehabilitation  of  tuberculous 
ex-service  men  has  been  worked  out  bj^  R.  H.  Harpster,  Educational 
Director  and  Dr.  John  W.  Turner.  It  is  founded  on  sound  eco- 
nomic and  pedagogical  principles  and  on  a  thorough  knowledge 
of  tuberculosis,  the  mode  of  development,  the  manner  and  rate  of 
its  healing  during  convalescence  and  the  psychology  and  physio- 
logy of  the  inactive  cases. 

The  thought  in  the  present  work  being  done  by  the  Rehabili- 
tation Division  of  this  Board  bring  us  back  to  the  period  just 
following  the  Civil  War  when  thousands  of  men  who  were  dis- 
abled, were  eventually  granted  compensation  or  a  pension,  as  it 
then  was  called,  and  allowed  to  go  on  their  way  thru  life. 

A  man  ma}^  be  able  to  exist  with  a  sufficient  amount  of  money 
to  live  on  from  the  Government  or  from  his  family,  but  in  this 
condition  he  is  not  independent  and  is  not  an  asset  to  the  com- 

35 


miuiity.  If  our  Pension  Bureau  records  were  available,  we  would 
find  that  tens  of  thousands  of  men  who  were  partially  disabled  by 
reason  of  their  Civil  War  duties,  have  been,  ever  since  that  time, 
doing  nothing  but  receiving  their  monthly  check  from  the  Govern- 
ment. If  they  had  been  given  a  course  of  training  which  w^ould 
have  given  them  an  opportunity  to  work  in  spite  of  and  with  their 
disabilities,  they  would  not  have  w^anted  to  continue  to  draw  this 
compensation  and  would  have  been  a  distinct  asset  to  the  com- 
munity in  which  they  lived. 

The  Government  at  the  present  time  does  not  propose  to 
alloAv  these  men  to  drift  into  a  life  which  will  make  them  de- 
pendent upon  the  monthly  mail  from  Washington  for  their  exist- 
ence. It  is  a  proven  fact  that  even  the  men  with  the  most  serious 
disabilities  can  learn  something  in  which  they  can  support  them- 
selves and  their  families  and  not  ask  for  Government  pension, 
charity  or  community  assistance.  They  will  become  independent 
of  all  of  this  which  is  so  distasteful  to  Americans,  and  educate 
themselves  into  some  niche  of  life  wherein  they  will  be  as  valuable 
to  the  community  as  are  their  more  able  bodied  neighbors,  and 
where  thej^  do  not  need  continually  to  ask  for  assistance. 

The  policy  of  the  Government  in  this  respect  is  so  markedlj^ 
changed  from  that  folloAving  the  Civil  War  that  it  is  worth  notice 
and  comment.  What  has  caused  the  change  is  doubtful,  but  it 
probably  can  be  attributed  to  the  general  progress  of  education  in 
this  country. 

The  success  of  Rehabilitation  work  thus  far,  has  indicated  to 
thinking  people  hoAv  unnecessary  it  is  to  allow  those  crippled  by 
industry  to  live  their  present  mode  of  existence.  The  chances  are 
very  good  that  out  of  the  work  now  being  accomplished  in  soldier 
rehabilitation,  results  will  come  which  Avill  revolutionize  this  un- 
fortunate phase  of  social  conditions  today. 

The  Bureau,  thru  Mr.  Charles  W.  Sylvester,  District  Vocational 
Officer  and  his  assistant,  Mr.  H.  J.  Betty,  are  arranging  in  con- 
nection with  Major  General  Leonard  Wood  and  the  Fort  Sheridan 
Association,  a  summer  vacation  at  Fort  Sheridan  for  more  than 
5000  of  its  students  during  the  summer  of  1921.  This  is  but  one 
of  the  many  indications  of  the  progressive,  humane  policies  of 
this  Board. 

The  results  secured  l)y  this  Board  are  due  to  the  fact  that 
responsihilifif  has  heen  definitehj  reqlonalizcd  and  treatment  has 
been  liberalized  and  red  tape  has  heen  cut.  The  responsible  local 
head  can  act.  No  case  qoes  to  Washington  for  decision  except  on 
an  appeal.    The  needs  of  ex-service  men  come  first. 

36 


THE  SERVICE  DEPARTMENT 

American  Legion  of  Illinois 

The  Service  Department  of  the  American  Legion  commenced 
its  functions  in  the  latter  part  of  March  1920.  At  that  time, 
Milton  J.  Foreman,  Commander  of  the  American  Legion  of  Illinois, 
realized  that  the  governmental  agencies  charged  with  the  care  of 
ex-service  men,  were  not  functioning,  and  that  it  would  be  neces- 
sary to  establish  an  agency  in  which  the  ex-service  men  would 
have  confidence  as  a  liaison  between  the  Government  and  these 
men,  because  the  burden  of  proof  lies  upon  the  claimant  and  he 
was  receiving  little  assistance  from  the  Government.  This  was 
due  to  the  fact  that  the  three  governmental  agencies,  namely  the 
Bureau  of  "War  Risk  Insurance,  the  Federal  Board  for  Vocational 
Education  and  the  United  States  Public  Health  Service  were  not 
efficientl}^  co-operating.  It  was  found  that  something  had  to  be 
done  to  connect  up  these  three  agencies  with  the  ex-service  men 
in  order  that  they  would  be  given  a  square  deal. 

The  work  was  organized  by  A.  H.  Ogle  who  was  the  first  direc- 
tor. In  the  first  month  of  the  work  of  the  Service  Department 
about  five  hundred  cases  were  handled.  This  number  gradually 
increased  up  to  October  1920,  when  about  twelve  hundred  cases, 
and  a  total  of  six  thousand  for  the  first  six  months,  had  been  ac- 
cepted for  settlement.  These  cases  ranged  from  claims  for  back 
pay  on  up  to  hospitalization  and  collection  of  death  claims. 

During  the  month  of  June  1920,  the  American  Legion,  De- 
partment of  Illinois,  conducted  a  whirlwind  campaign  regarding 
the  benefits  of  War  Risk  Insurance  and  was  instrumental,  with 
the  assistance  of  the  local  representative  of  the  Bureau  of  War 
Risk  Insurance,  in  having  reinstated  over  thirteen  million  dollars 
worth  of  War  Risk  Insurance.  At  this  time  J.  W.  Lyden  was 
Assistant  Director  of  the  Service  Department  and  John  A.  Hart- 
man  was  in  charge  of  the  insurance  campaign. 

In  October  1920,  William  R.  McCauley  assumed  his  duties  as 
State  Commander,  Wm.  Q.  Setliffe  was  appointed  Director  and 
John  A.  Hartman,  Assistant  Director  of  the  Service  Department 
at  the  Chicago  office.  Steps  were  immediately  taken  to  secure 
proper  co-operation  with  the  different  Bureaus.  They  were  in  a 
great  measure  successful.  Co-operation  was  secured  with  the  U.S. 
P.H.S.  Hospital  No.  30,  through  Dr.  Wilcox  G.  Thorne,  the  Fed- 
eral Board  for  Vocational  Education,  Mr.  Charles  W.  Sjdvester, 
Director,  through  Mr.  H.  J.  Betty,  liaison  officer,  and  with  the  U.S. 
P.H.  Service,  through  Dr.  Witte.  An  account  of  the  present  work 
of  the  Service  Department  is  given  below: 

37 


Considerable  difficulty  was  experienced  regarding  the  care  and 
protection  of  the  men  who  were  insane  or  mentally  unbalanced. 
These  men  passed  through  the  psychopathic  court  and  were  farmed 
out  to  different  insane  asjdums  Avithout  any  effort  being  made  to 
connect  their  disability  with  their  military  service.  This  has 
caused  considerable  confusion  and  added  a  great  expense  to  the 
various  counties  and  the  result  has  been  that  there  were  main- 
many  insane  men  who  are  ex-service  men  who  have  never  had  their 
compensation  claims  taken  up  and  little  has  been  done  to  protect 
their  interests. 

The  Service  Department  arranged  a  plan  Avhoreby  all  of  the 
county  clerks  in  the  one  hundred  and  two  counties  in  Illinois  will 
notify  the  American  Legion  Commander  in  their  towns  whenever 
an  ex-service  man  comes  up  for  trial  as  to  his  sanity.  Forms  526, 
539  and  545  are  then  made  out  for  the  man  by  the  American 
Legion  Commander  and  forwarded  to  the  District  Supervisor  of 
the  United  States  Public  Health  Service.  Under  this  plan  the 
man  immediately  becomes  a  ward  of  the  government,  at  least  for 
observation  purposes  and  until  such  time  as  his  claim  is  estab- 
lished with  the  Bureau  of  War  Risk  Insurance. 

In  Februar}',  as  the  result  of  a  conference  between  Department 
Commander,  Wm.  R.  McCauley,  Dr.  Witte  and  Mr.  Hartman,  an 
agreement  was  entered  into  whereby  a  liaison  officer  has  been 
appointed  by  the  United  States  Public  Health  Service,  and  all 
differences  of  opinion  and  questions  arising  regarding  hospitaliza- 
tion are  referred  to  this  office,  which  settles  them,  if  possible,  and 
if  not  they  are  referred  to  higher  authority. 

The  Department  Commander  dedicated  the  Legion  to  one 
duty  for  the  year  1920-21,  namely,  that  of  service.  That  this  idea 
has  been  practical  is  proved  by  the  fact  that  the  number  of  claims 
handled  by  Chicago  office  of  the  Service  Department  has  jumped 
from  some  thirteen  hundred  eases  in  October  to  ten  thousand  and 
six  during  the  month  of  February. 

A  Legal  Department  is  maintained  in  this  office  and  questions 
regarding  the  appointment  of  conservators,  administrators,  etc. 
are  taken  care  of. 

During  the  latter  part  of  the  year  1920,  the  Legion  has  been 
instrumental  in  closing  two  contract  hospitals,  namely  Sunnybrook 
Farm  and  St.  Paul's  Hospital.  A  number  of  Public  Health  Service 
examiners  have  been  removed  l)ecanse  of  their  failure  to  understand 
the  point  of  view  of  the  ex-service  men. 

In  a  conference  between  Assistant  Surgeon-General  Lavinder 
and  Commander  William  R.  McCauley,  Adjutant  Wm.  Q.  Setliffe 

38 


and  John  Hartman,  Dr.  Lavinder  agreed  to  cancel  the  contract  of 
Cook  County  Tuberculosis  Sanitarium  at  Oak  Forest,  just  as  soon 
as  hospital  space  for  the  ex-service  men  who  are  now  patients  at 
that  hospital  can  be  secured  elsewhere. 

For  about  six  weeks  during  November  and  December,  this 
Service  Department  maintained  an  employment  bureau  for  ex- 
service  men  and  was  instrumental  in  placing  about  two  hundred 
and  fifty  men  in  employment.  During  the  same  time  about  four 
hundred  dollars  was  expended  for  meal  tickets,  lodging  and  emer- 
gency assistance  for  these  men.  This  employment  bureau  was  dis- 
continued because  of  the  desire  of  the  American  Legion  to  co- 
operate with  the  Central  Employment  Bureau,  which  is  under  the 
control  of  the  Illinois  Free  Employment  Bureau.  We  have  re- 
ceived uniform  satisfaction  from  this  Bureau. 

The  State  of  Illinois  has  been  divided  into  districts.  These 
districts  are  under  the  supervision  of  the  different  County  Central 
Committees,  who  have  the  hospital  within  the  district  assigned  to 
them  and  who  are  responsible  for  the  proper  inspection  and 
reports.  These  inspections  are  made  weekly  and  include  a  gen- 
eral report  on  conditions  found.  Particular  attention  is  paid  to 
the  quarters,  food,  medical  treatment  and  general  surroundings. 
A  report  is  made  to  this  office  and  if  any  complaints  are  regis- 
tered they  are  immediately  taken  up  through  this  office  with  the 
district  supervisor  of  the  U.S.P.H.S.  with  a  view  to  remedying 
conditions  without  any  delay. 

In  addition  to  this  work,  the  Legion  Posts  in  the  towns  in 
which  hospitals  are  located,  have  been  furnished  with  a  supply  of 
forms  (as  used  in  the  hospital  census)  which  are  filled  out  for 
each  patient  admitted.  All  necessary  information  is  secured  and 
these  forms  are  forwarded  to  Chicago  to  this  office.  If  the  man's 
claim  is  already  in  our  file  or  a  hospital  card  has  already  been 
filled  out,  the  additional  information  is  placed  on  the  card.  If 
there  is  no  card  in  our  file,  they  immediately  take  it  up  with  the 
Bureau  of  War  Risk  Insurance  and  endeavor  to  secure  an  adjust- 
ment and  prompt  action. 

In  addition  to  the  above,  the  post  or  several  posts  in  the 
vicinity  of  each  hospital  visit  it  at  intervals  and  mingle  with  the 
patients  and  assist  them  in  every  way  possible.  Entertainment  is 
provided  and  whenever  possible  patients  are  taken  for  automobile 
rides,  etc.  The  entire  policy  is  to  see,  not  how  much  you  can  give 
the  man,  but  how  much  you  can  do  for  him.  The  hospitals  in  the 
Chicago  district  are  very  well  taken  care  of  for  the  reason  that 
there  are  so  many  more  posts  than  hospitals.  Various  entertain- 
ments are  provided  and  on  an  average  of  three  posts  visit  each 
institution  weekl3^ 

39 


Over  the  entire  Illinois  District,  instead  of  going  to  the  hos- 
pitals Avitli  fruit  or  what  might  be  termed  useless  articles,  a  spirit 
of  eo-opcralion  has  heon  establislicd  and  information  is  secured 
from  this  office  prior  to  the  visit  as  to  just  -what  the  men  need  or 
desire.  It  has  been  noted  that  posts  visiting  hospitals  have  over- 
looked the  fact  that  tooth  brushes,  tooth  paste,  shaving  brushes 
and  soap,  and  razors  are  needed  in  a  great  many  instances.  This 
has  been  corrected.  It  has  also  been  noticed  that  Avell  meaning 
persons  have  sometimes  visited  hospitals  with  fruit,  candy,  etc., 
and  handed  them  out  to  the  patients  without  regard  to  special 
treatment  certain  patients  were  receiving.  In  this  w^ay  patients  on 
a  diet  have  been  furnished  with  articles  of  food  forbidden  by  the 
doctor.  This  has  been  remedied  by  asking  the  committees  visiting 
hospitals  to  consult  with  the  hospital  authorities  in  order  to  prevent 
upsetting  the  patient's  diet. 

The  condition  of  dependents  of  ex-service  men  has  also  been 
investigated  and  their  needs  taken  care  of  by  the  various  posts. 

Heretofore  individual  posts  in  the  different  communities  have 
visited  hospitals  on  their  own  initiative  and  although  conditions 
needing  attention  were  remedied,  the  office  had  no  knowledge  of 
what  w^as  done  and  in  many  instances  this  resulted  in  duplication 
of  effort  and  neglect- of  some  hospitals.  Under  the  present  pro- 
gram, all  of  the  hospitals  are  visited  regularly  through  instructions 
from  these  headquarters  and  in  this  way  there  is  no  danger  of  one 
hospital  receiving  four  visits  and  other  hospitals  not  receiving  any. 

It  is  noticed  that  within  the  past  four  months,  posts  have 
become  interested  in  Dunning,  Elgin,  Jacksonville  and  Kankakee 
asylums  and  these  hospitals  or  asylums  are  visited  regularh'  and 
articles  of  comfort  provided.  This  was  not  true  in  the  past  be- 
cause of  the  fact  that  the  average  individual  knew  nothing  of 
conditions  surrounding  insane  ex-service  men. 

During  the  Christmas  Holiday's  every  hospital  in  the  state  of 
Illinois  where  ex-service  men  were  receiving  treatment,  was  visited 
and  a  Christmas  program  provided.  This  program  consisted  of  a 
Christmas  tree,  presents  to  the  individual  and  a  general  spirit  of 
comradeship.  Some  of  this  work  w^as  done  by  the  local  posts  and 
in  some  instances  by  headquarters,  with  the  assistance  of  local 
posts.  At  Elgin  the  local  post  of  the  American  Legion  furnished 
a  Christmas  dinner  for  all  of  the  ex-service  men  in  the  Elgin  State 
Hospital  and  all  who  could  possibly  do  so  visited  the  hospital  and 
sat  down  at  this  Christmas  dinner.  In  the  afternoon  an  entertain- 
ment program  was  furnished,  wdiich  was  well  attended  by  both  the 
patients  and  the  members  of  the  post  with  their  friends.  This  is 
typical  of  the  visits  paid  to  the  hospitals  in  the  state  on  that  day. 

A  spirit  of  co-operation  has  been  established  in  the  different 
hospitals  and  this  plan  has  resulted  in  the  ex-service  men  being 
treated  with  better  understanding  of  their  condition  than  hereto- 
fore. 

40 


THE  BED  CROSS 

The  record  of  the  Red  Cross  in  military  hospitals  is  well 
understood.  Under  present  conditions  they  are  still  doing  a  work 
of  outstanding  importance.  The  Central  Divisional  Offices  take 
charge  of  the  work  in  hospitals  actualH^  controlled  by  the  U.  S. 
Public  Health  Service.  The  Chicago  Chapter  and  other  chapters 
throughout  the  State  undertake  it  in  contract  hospitals. 

The  Central  Division  is  responsible  for  Red  Cross  activities  in 
U.  S.  Marine  Hospital  No.  5,  4141  Clarendon  Ave.,  where  they 
have  three  full  time  and  one  part  time  worker  with  Miss  Estelle 
Schulte  as  chief  of  the  department;  U.S.P.H.S.  Hospital  No.  30, 
47th  &  Drexel  Blvd.,  where  they  have  thirteen  full  time  workers 
and  one  part  time  worker  with  Mr.  Maurice  R.  Reddy  as  chief ; 
and  U.S.P.H.S.  Hospital  No.  53,  Dwight,  111.,  where  they  have 
three  workers  with  Miss  Alice  J.  Barker  as  chief. 

The  work  of  these  departments  is  as  follows: 

Shortly  after  a  patient  is  admitted  to  the  hospital,  he  is  inter- 
viewed by  a  Red  Cross  worker,  who  takes  up  with  him  the  subjects 
of  compensation,  insurance,  and  Federal  Board  training,  with  a 
view  to  assisting  him  in  adjusting  any  claims  that  may  be  pending, 
and  at  the  same  time,  learning  of  any  possible  difficult}^  the  man 
may  be  having,  in  which  the  Red  Cross  might  be  of  assistance  to 
him  or  his  family. 

During  the  man's  stay  in  the  hospital,  many  minor  services 
are  rendered  him  by  the  Red  Cross.  In  cases  where  compensation 
has  not  been  received,  or  all  his  compensation  is  needed  for  his 
family,  loans  or  grants,  as  the  situation  requires,  are  made  by  the 
Red  Cross.  These  loans  or  grants  are  often  necessary'  because  of 
needed  clothing,  transportation  home,  and  other  miscellaneous  ex- 
penditures. 

When  a  diagnosis  of  tuberculosis  is  made,  the  Red  Cross 
Avorker  immediately  gets  in  touch  with  the  man's  local  Home 
Service,  asking  that  every  effort  be  made  to  have  the  rest  of  the 
family  examined  for  T.  B.  and  proper  hygiene  and  nourishment 
to  any  of  the  familj^  who  might  be  a  suspicious  case.  They  believe 
preventive  work  in  tuberculosis  is  a  dut3^ 

In  the  case  of  severe  illness  of  an  out-of-town  patient  in  the 
hospital,  it  is  the  duty  of  the  Red  Cross  to  keep  the  family  in- 
formed as  to  the  man's  condition. 

In  the  case  of  death,  all  possible  assistance  is  given  any  rela- 
tives who  may  be  visiting  the  hospital  at  the  time,  and  the  man's 
Local  Home  Service  is  communicated  with,  in  order  that  any 
possible  needed  assistance  in  arranging  the  details  of  the  funeral 
may  be  given.  Also  it  is  customary  for  the  Red  Cross  to  send  to 
the  man's  Local  Home  Service  any  information  thej-  may  have 
regarding  the  status  of  his  compensation  and  insurance ;  and  if  no 
relatives  were  present,  information  regarding  the  details  sur- 
rounding the  patient's  last  hours  that  could  possibly,  be  of  any 
comfort  to  the  family. 

41 


In  these  letters,  there  is  a  definite  request  for  the  Red  Cross 
worker  to  call  at  the  home  and  render  any  assistance  to  the  family. 

On  the  discharge  of  patients  from  the  hospitals,  a  letter  is 
sent  to  the  man's  Local  Home  Service  describing  the  nature  of  his 
trouble,  his  present  condition,  the  doctor's  advice  for  proper  after- 
care including  points  regarding  recreation,  diet  and  hygiene,  the 
date  and  place  of  his  next  examination,  what  has  been  accomplished 
on  adjusting  the  patient's  compensation,  insurance,  or  vocational 
training  while  he  has  been  in  the  hospital,  together  with  a  definite 
request  for  a  reply,  whether  or  not  it  has  been  possible  to  arrange 
for  the  doctor's  directions  to  be  carried  out.  The  types  of  cases 
the  Red  Cross  is  especially  anxious  to  do  such  follow-up  work  on, 
are  mental  eases,  tuberculosis,  heart,  nephritis,  diabetes,  gastro- 
intestinal condition,  and  orthopedic  troubles,  including  major  am- 
putations. 

In  each  of  these  hospitals,  the  Red  Cross  has  a  full  time  re- 
creational worker,  who  arranges  for  entertainment  for  the  patient 
personnel.  They  work  in  co-operation  with,  and  direct,  any  volun- 
teer entertainment  offered  by  organizations  or  individuals.  The 
recreational  workers  make  an  effort  to  develop  a  plan  of  recreation 
for  ward  patients  who  are  able  to  go  out  on  pass. 

From  February  first,  1921,  the  Chicago  Chapter  of  the  Amer- 
ican Red  Cross  undertook  to  furnish  social  service  to  the  men  in 
contact  hospitals  within  its  territory,  and  a  staff  of  five  workers  is 
now  looking  after  their  needs. 

When  a  maii  enters  the  hospital,  if  he  has  not  proper  clothing, 
he  is  at  once  given  two  suits  of  pajamas,  a  bathrobe,  a  pair  of  slip- 
pers, and  in  the  tuberculosis  hospitals  a  thermometer  is  given  also. 
Immediate  inquiry  is  made  into  the  state  of  his  government  claims, 
and  the  necessary  steps  are  taken  to  hasten  compensation  if  it  is 
not  being  received.  Moiiey  for  personal  needs  is  furnished  those 
Avho  have  none.  Games,  reading  matter  and  cigarettes  are  pro- 
vided. 

If  the  patient  is  from  another  cit.y  and  is  worried  about  his 
family,  these  w'orkers  communicate  with  the  Red  Cross  in  his  home 
town  and  establish  means  of  communications  which  usiuilly  relieves 
his  anxiety  at  once. 

In  February,  350  men  were  under  care  in  contract  hospitals. 
Of  these  1,8G  were  given  cash  relief  or  new  clothing,  and  298  were 
given  many  forms  of  service,  such  as  writing  letters,  adjusting 
personal  affairs,  and  attending  to  necessary  business  matters  for 
them. 

These  workers  also  distribute  gifts  of  fruit,  candy  and  deli- 
cacies. 

The  Chapter  has  also  established  a  follow-up  service  for  men 
discharged  from  the  hospitals  into  the  out-patient  group.  The  Red 
Cross  undertakes  to  see  that  the  man  returns  for  treatment  at  the 
required  times  and  that  the  physician's  instructions  are  carried 
out  in  the  Jiome.  The  proper  diet  is  provided,  and  the  housewife 
instructed  in  its  preparaliou  if  necessar}'. 

42 


CONCLUSIONS 

Specific  Suggestioxs  for  the  Future. 

A — Completion  of  the  Speedway  Hospital 

The  most  important  question  is  the  proper  hospitalization  of 
tubercular  and  neuro-psychiatric  cases.  The  Government  has  had 
this  hospital  under  construction  for  the  last  three  years.  It  is 
located  some  eight  miles  west  of  the  Chicago  Loop.  The  buildings 
are  practically  completed,  at  a  cost  of  more  than  $5,000,000.  It 
should  be  available  for  patients  during  the  mid-summer  of  1921. 
A  great  deal  remains  to  be  done  to  make  the  Speedway  a  proper 
place  for  ex-service  men.  There  are  320  acres  of  open  land  without 
trees,  natural  shrubbery  or  recreational  facilities.  Immediate  ef- 
forts should  be  made  to  start  to  work  out  the  proper  landscape 
features,  the  proper  recreational  facilities,  the  question  of  trans- 
portation and  community  relationships.  There  are  no  transporta- 
tion facilities  nearer  than  two  miles  except  the  spur  of  the  Illinois 
Central,  which  might  furnish  transportation  for  some.  The  Speed- 
way will  help  to  solve  some  of  the  difficult  hospitalization  j)rob- 
lems  but  in  order  to  do  it  adequately,  action  must  be  taken  at  once 
so  that  ex-service  men  hospitalized  there  may  have,  as  far  as  pos- 
sible, conditions  of  normal,  happy,  healthy  life  about  them. 

B — A  State  Hospital  for  Mental  Cases 

The  best  memorial — the  finest  appreciation  for  the  service  of 
men  throughout  the  war  will  be  a  splendid  state  hospital  for  re- 
habilitation and  care  of  mental  cases  erected  in  memory  of  their 
service.  Such  a  hospital  well  located  would  assure  the  men  of  this 
state  who  have  suffered  from  the  War  and  their  families,  the  very 
best  medical  care  during  the  next  ten  years,  when  physical  and 
medical  conditions  growing  out  of  the  war  will  warrant  the  ex- 
penditure at  this  time  of  this  amount  of  money.  ,Otlier  states  are 
considering  the  matter  very  seriously.  Wisconsin  is  building  a 
memorial  hospital  at  the  Universitj'  at  Madison.  New  York  ap- 
propriated three  million  dollars  for  a  hospital  for  mental  diseases 
and  citizens  of  Illinois  may  well  consider  the  matter  as  a  contri- 
bution of  the  State  to  a  great  and  worthy-  purpose.  In  view  of  the 
fact  that  up  to  date  Illinois  has  never  officially  taken  any  cogni- 
zance of  the  condition  of  men  who  were  sick  or  disabled  in  the  serv- 
ice, no  better  way  could  be  discovered  for  covering  up  this  failure  in 
the  past  than  by  doing  her  full  share  at  this  time  and  protecting 
the  future  of  these  men. 

C — Training  Farm  for  After  Hospital  Care  for  Mental  Cases 

Great  difficulty  has  been  experienced  by  the  Federal  Board  in 
arranging  the  proper  training  facilities  for  mental  cases  after  they 
have  left  the  hospital.  It  has  been  proposed  that  a  farm  be  secured 
with  all  the  proper  buildings  for  living  accommodations  together 
Avith  sufficient  space  for  work  shops  and  school  rooms.     An  investi- 

43 


gat  ion  is  at  this  time  being  made  for  such  an  arrangement.  It  is 
expected  that  this  project  for  mental  cases,  which  will  parallel  the 
Nauvoo,  Illinois  school  which  is  taking  care  of  150  ex-service  men 
with  inactive  tuberculosis,  may  be  made  by  the  board  of  vocational 
education. 

D — Complete   Unification,    Departmentalization    and    Decentral- 
ization of  Bureaus 

It  is  generally  agreed  that  the  situation  in  this  state  with 
reference  to  compensation  and  care  of  the  disabled  and  sick  ex-serv- 
ice man  will  never  be  satisfactorily  solved  until  the  various  depart- 
ments are  in  one  office  when  he  can  receive  complete  attention  in 
the  matter  of  compensation  and  hospitalization  and  vocational 
training,  where  one  complete  file  will  contain  everything  affecting 
his  case ;  when  there  will  be  no  shifting  of  responsibility,  no  passing 
of  the  buck  from  one  bureau  to  another. 

One  office  in  Washington  will  not  do  this.  There  must  be  a 
number  of  regional  offices  throughout  the  country  with  power  to 
act.  To  this  end  the  American  Legion,  through  its  national  hos- 
pitalization committee  of  which  General  Abel  Davis  of  Chicago  is 
chairman  and  its  legislative  committee,  have  been  working  for 
some  time.  The  Committee  of  the  American  Legion  favors  and  is 
working  for  legislation  which  will  bring  about  a  unified,  depart- 
mentized  and  decentralized  agency  for  the  care  of  disabled  soldiers. 

All  activities  of  the  Government  for  the  purpose  of  general 
direction  should  be  placed  in  one  department  of  the  Government, 
in  such  a  way  as  to  avoid  duplication  of  functions  or  conflict  of 
authority. 

Every  phase  of  the  problem  is  important  enough  to  be  handled 
in  a  separate  department.  As  an  illustration,  the  department  of 
insurance  would  find  enough  work  in  looking  after  that  one  phase 
of  the  problem.  Similarly,  the  department  of  compensation  is  im- 
portant in  itself  and  should  in  no  way  conflict  with  or  overlap  the 
work  of  hospitalization.  All  medical  service  and  hospitalization 
should  be  placed  in  a  separate  department.  It  is  believed  that  the 
United  States  Public  Health  Service,  which  has  the  personnel  and 
the  necessary  experience,  might  be  given  the  task  of  perfecting 
such  a  department.  The  Federal  Board  of  vocational  training  is 
also  of  sufficient  importance  to  be  a  separate  department.  All  of 
these  departments  should  function  under  the  direct  supervision  and 
authorit}^  of  the  one  head — The  Assistant  Secretary. 

It  is  not  fair  to  the  disabled  man  to  make  Washington  the  only 
place  where  he  can  get  a  hearing  on  this  case.  Each  state  or  other 
subdivision  agreed  to  should  have  an  office  where  final  decisions 
can  l)e  reached  on  all  matters  affecting  the  soldier,  whether  it  is 
compensation,  hospitalization  or  vocational  training.  This  is  now 
true  of  vocational  training  and  hospitalization.  On  appeal,  or  for 
other  specially  stated  reasons,  a  case  might  be  reviewed  and  finally 
decided  in  Washington.     The  main  cause  of  delay  and  much  in- 

44 


convenience  and  discomfort  to  the  soldier  is  the  fact  that  the  main 
office  in  Washington  decided  each  individual  case  at  long  distance, 
acting  on  reports,  without  an  opportunitj'  to  see  the  man  and  his 
actual  surroundings. 

£ — Clinics  and  Home  Visitation 

It  is  of  great  importance  that  medical  facilities  be  made  easily 
accessible  for  men  who  are  claimants  of  the  War  Risk  Bureau  but 
who  are  not  hospitalized.  Frequently  the  Public  Health  Service 
must  take  the  initiative  in  the  treatment  of  those  claimants.  The 
development  of  Public  Health  Service  clinics  will  meet  this  need. 

Home  visitation  work  by  the  Public  Health  Service  and  by 
the  Red  Cross  are  of  the  greatest  importance  in  order  that  men 
may  receive  satisfactory  medical  treatment,  not  in  the  hospitals. 
By  early  c^re  much  diffi<3ult  work  of  hospitalization  can  be  pre- 
vented to  the  mutual  advantage  of  the  men  and  the  Government. 

THE  STATE  AT  WORK 

Our  communities  throughout  the  state  have  been  interested  in 
the  disabled  soldier.  Difficulty  has  been  experienced  in  having 
such  interest  manifest  itself  along  helpful  lines.  Chicago  finally 
found  a  way  for  an  expression  of  such  interest  along  highly  con- 
structive lines.  The  Union  League  Club,  through  its  Committee 
on  Public  Affairs,  headed  by  Britten  I.  Budd,  after  consultation 
with  the  Service  Department  of  the  American  Legion  and  a  number 
of  individuals  who  had  been  interested  in  the  situation,  assumed 
the  responsibility  for  a  specific  plan,  (a)  completion  of  the  Speed- 
way Hospital,  the  beautification  of  its  surroundings,  providing 
recreational  facilities  and  transportation,  general  supervision  of 
the  hospital  as  a  public  interest,  and  (b)  to  secure  from  the  legisla- 
ture the  necessary  appropriation  for  the  erection  of  a  State 
Memorial  Hospital  for  the  treatment  of  insane  cases  among  ex- 
service  men,  and  the  establishment  of  a  committee  to  continue  its 
interest  and  supervision  in  the  whole  field  of  treatment  of  the  dis- 
abled veterans. 

With  his  own  plans  as  a  basis,  Mr.  Budd  has  secured  the  co- 
operation of  the  Illinois  Chamber  of  Commerce  and  made  the  con- 
crete suggestion  that,  through  this  organization,  each  community, 
after  ascertaining  the  local  situation,  assume  responsibility  along 
certain  specific  lines  of  helpfulness.  You  can  express  best  your 
interest  in  the  soldier  by  helping  in  each  community  the  organiza- 
tion of  a  group  of  men  who  will  charge  themselves  with  the  re- 
sponsibility of  putting  into  execution  Illinois'  plan  for  the  future: 

The  good  will  of  the  American  people  must  he  made  to  express 
itself  fully  through  the  efficient  work  of  Government  departments. 
But  each  and  every  American  citizen  should  do  his  share  tvhenever 
he  crosses  the  path  of  a  sick  or  disabled  ex-service  man,  to  make 
his  life  as  useful,  as  self-respecting,  as  strong  as  the  united  efforts 
of  a  grateful  people  can  make  it. 

45 


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